Provider Demographics
NPI:1720273675
Name:DR.JEREMY MCKELROY
Entity Type:Organization
Organization Name:DR.JEREMY MCKELROY
Other - Org Name:MCKELROY FAMILY CHIROPRACTIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:T
Authorized Official - Last Name:MCKELROY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:870-802-9355
Mailing Address - Street 1:300 SOUTHWEST SQ
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-5984
Mailing Address - Country:US
Mailing Address - Phone:870-802-9355
Mailing Address - Fax:870-802-1057
Practice Address - Street 1:300 SOUTHWEST SQ
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5984
Practice Address - Country:US
Practice Address - Phone:870-802-9355
Practice Address - Fax:870-802-1057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C500Medicare PIN