Provider Demographics
NPI:1780815290
Name:KELLNER, MICHAEL S (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:KELLNER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ROTTAU AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08068-1919
Mailing Address - Country:US
Mailing Address - Phone:609-894-0237
Mailing Address - Fax:
Practice Address - Street 1:1275 WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065-1900
Practice Address - Country:US
Practice Address - Phone:848-235-5603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-31
Last Update Date:2021-04-14
Deactivation Date:2021-02-24
Deactivation Code:
Reactivation Date:2021-04-12
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
NJ38MC00780700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer