Healthcare Provider Details

I. General information

NPI: 1851007652
Provider Name (Legal Business Name): MACKENZIE KELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2023
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 S FRONT ST
NEW BERN NC
28560-2136
US

IV. Provider business mailing address

1145 BROAD CREEK RD
NEW BERN NC
28560-7153
US

V. Phone/Fax

Practice location:
  • Phone: 252-514-0092
  • Fax:
Mailing address:
  • Phone: 570-533-1553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5619
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: