Healthcare Provider Details

I. General information

NPI: 1962505198
Provider Name (Legal Business Name): RICKEY D KELLER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 W SOUTHERN AVE STE B1
APACHE JUNCTION AZ
85220
US

IV. Provider business mailing address

PO BOX 6818
APACHE JUNCTION AZ
85278
US

V. Phone/Fax

Practice location:
  • Phone: 480-982-9272
  • Fax: 480-982-9295
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4153
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: