Provider Demographics
NPI:1255701751
Name:KELLER CHIROPRACTIC, P.L.L.C.
Entity type:Organization
Organization Name:KELLER CHIROPRACTIC, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:810-360-8135
Mailing Address - Street 1:600 E GRAND RIVER AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1983
Mailing Address - Country:US
Mailing Address - Phone:810-360-8135
Mailing Address - Fax:810-360-0717
Practice Address - Street 1:600 E GRAND RIVER AVE STE 2
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1983
Practice Address - Country:US
Practice Address - Phone:810-360-8135
Practice Address - Fax:810-360-0717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009416111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty