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General NPI Number Information
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NPI Number | 1588984546
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Entity Type | Organization
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Legal Business Name | KELLER CHIROPRACTIC
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Dates
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Enumeration Date | 06/01/2010
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Last Update Date | 06/01/2010
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Provider Practice Location Address
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Address Line | 104 10TH ST SW
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City | WAVERLY
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State | IA
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Zip | 50677-2924
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Country | US
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Telephone | 319-352-4517
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Fax | 319-352-4518
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Provider Business Mailing Address
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Address Line | 104 10TH ST SW PO BOX 121
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City | WAVERLY
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State | IA
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Zip | 50677-2924
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Country | US
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Telephone | 319-352-4517
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Fax | 319-352-4518
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. VALARIE J KELLER
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Credential | D.C.
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Telephone | 319-352-4517
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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 | O6917
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License Number State | IA
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