Provider Demographics
NPI:1972662823
Name:KELLER AND WOLF CHIROPRACTIC CLINIC LLC
Entity Type:Organization
Organization Name:KELLER AND WOLF CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-765-2720
Mailing Address - Street 1:105 E BLAINE AVE
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:SD
Mailing Address - Zip Code:57442-1167
Mailing Address - Country:US
Mailing Address - Phone:605-765-2720
Mailing Address - Fax:
Practice Address - Street 1:105 E BLAINE AVE
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:SD
Practice Address - Zip Code:57442-1167
Practice Address - Country:US
Practice Address - Phone:605-765-2720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS40613Medicare ID - Type Unspecified