=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245270578
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VALARIE JEAN KELLER D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2006
-----------------------------------------------------
Last Update Date | 10/26/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 104 10TH ST SW
-----------------------------------------------------
City | WAVERLY
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50677-2924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-352-4517
-----------------------------------------------------
Fax | 319-352-4518
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 104 10TH ST SW
-----------------------------------------------------
City | WAVERLY
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50677-2924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-352-4517
-----------------------------------------------------
Fax | 319-352-4518
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 06917
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------