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NPI Code Detail

MEDICARE: INNOVATIVE MEDICINE INSTITUTE INC

MEDICARE: INNOVATIVE MEDICINE INSTITUTE INC
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
1111NS0005XSports Physician Chiropractor4153AZ

General Provider Information

NPI Number : 1831315084
Entity Type Code : Organization
Provider Name (Legal Business Name) : INNOVATIVE MEDICINE INSTITUTE INC
Provider Business Mailing Address
First Line : PO BOX 6818
Second Line :
City : APACHE JUNCTION
State : AZ
Zip : 85278-6818
Country : US
Telephone Number : 480-982-9272
Fax Number : 480-982-9295
Provider Business Practice Location Address
First Line : 2080 W SOUTHERN AVE
Second Line : SUITE B-1
City : APACHE JUNCTION
State : AZ
Zip : 85220-7455
Country : US
Telephone Number : 480-982-9272
Fax Number : 480-982-9295
Authorized Official
Title or Position : PRESIDENT
Name : DR. RICKEY DUAINE KELLER
Credential : D.C.
Telephone Number : 480-982-9272
Provider Enumeration Date : 04/17/2007
Last Update Date : 08/22/2020

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Directions to “INNOVATIVE MEDICINE INSTITUTE INC ” Practice Location

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