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General NPI Number Information
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NPI Number | 1255701751
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Entity Type | Organization
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Legal Business Name | KELLER CHIROPRACTIC, P.L.L.C.
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Dates
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Enumeration Date | 09/28/2015
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Last Update Date | 09/28/2015
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Provider Practice Location Address
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Address Line | 600 E GRAND RIVER AVE STE 2
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City | BRIGHTON
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State | MI
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Zip | 48116-1983
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Country | US
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Telephone | 810-360-8135
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Fax | 810-360-0717
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Provider Business Mailing Address
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Address Line | 600 E GRAND RIVER AVE STE 2
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City | BRIGHTON
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State | MI
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Zip | 48116-1983
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Country | US
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Telephone | 810-360-8135
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Fax | 810-360-0717
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. RONALD DALE KELLER II
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Credential | D.C.
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Telephone | 810-360-8135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2301009416
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License Number State | MI
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