Healthcare Provider Details

I. General information

NPI: 1083694657
Provider Name (Legal Business Name): MICHAEL ALAN KELLER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 02/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 W. GRAND CROSSING
MOBRIDGE SD
57601-2046
US

IV. Provider business mailing address

404 W. GRAND CROSSING
MOBRIDGE SD
57601-2046
US

V. Phone/Fax

Practice location:
  • Phone: 605-845-7808
  • Fax: 605-845-5808
Mailing address:
  • Phone: 605-845-7808
  • Fax: 605-845-5808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number847
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: