Healthcare Provider Details

I. General information

NPI: 1982908018
Provider Name (Legal Business Name): KELLER CHIROPRACTIC CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2011
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: DR. MICHAEL ALAN KELLER
Title or Position: OWNER
Credential: D.C.
Phone: 605-845-7808