Healthcare Provider Details

I. General information

NPI: 1740382621
Provider Name (Legal Business Name): KELLER AND WOLF CHIROPRACTIC CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 09/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 W GRAND XING
MOBRIDGE SD
57601-1007
US

IV. Provider business mailing address

1711 W GRAND XING
MOBRIDGE SD
57601-1007
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 Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL ALAN KELLER
Title or Position: CO-OWNER
Credential: D.C.
Phone: 605-845-7808