Provider Demographics
NPI:1790973881
Name:KELLERMAN, RANDY LEE (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:LEE
Last Name:KELLERMAN
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7210 WORNALL RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-1345
Mailing Address - Country:US
Mailing Address - Phone:816-333-2533
Mailing Address - Fax:816-333-2586
Practice Address - Street 1:7210 WORNALL RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-1345
Practice Address - Country:US
Practice Address - Phone:816-333-2533
Practice Address - Fax:816-333-2586
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007030924111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor