MEDICARE: DR. JASON KENWOOD KELTGEN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4308	WI

General Provider Information

NPI Number	:	1154526663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON KENWOOD KELTGEN D.C.

Provider Business Mailing Address
First Line	:	1444 EGG HARBOR RD
Second Line	:
City	:	STURGEON BAY
State	:	WI
Zip	:	54235-1240
Country	:	US
Telephone Number	:	920-743-2200
Fax Number	:	920-743-2250

Provider Business Practice Location Address
First Line	:	1444 EGG HARBOR RD
Second Line	:
City	:	STURGEON BAY
State	:	WI
Zip	:	54235-1240
Country	:	US
Telephone Number	:	920-743-2200
Fax Number	:	920-743-2250

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2007
Last Update Date	:	10/06/2016

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