Provider Demographics
NPI:1184781171
Name:KELLER FAMILY CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:KELLER FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-467-2486
Mailing Address - Street 1:10400 LANCASTER NEWARK RD NE
Mailing Address - Street 2:
Mailing Address - City:MILLERSPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43046-8003
Mailing Address - Country:US
Mailing Address - Phone:740-467-2486
Mailing Address - Fax:740-467-2498
Practice Address - Street 1:10400 LANCASTER NEWARK RD NE
Practice Address - Street 2:
Practice Address - City:MILLERSPORT
Practice Address - State:OH
Practice Address - Zip Code:43046-8003
Practice Address - Country:US
Practice Address - Phone:740-467-2486
Practice Address - Fax:740-467-2498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========-00OtherBUREAU OF WORK COMP
OH9367171Medicare PIN