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General NPI Number Information
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NPI Number | 1881858231
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Entity Type | Organization
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Legal Business Name | KELLENBERGER CHIROPRACTIC CLINIC SC
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Dates
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Enumeration Date | 07/15/2008
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Last Update Date | 07/15/2008
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Provider Practice Location Address
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Address Line | 425 N LIBERTY ST
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City | ELGIN
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State | IL
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Zip | 60120-4268
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Country | US
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Telephone | 847-742-5070
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Fax | 847-742-3121
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Provider Business Mailing Address
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Address Line | 425 N LIBERTY ST
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City | ELGIN
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State | IL
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Zip | 60120-4268
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Country | US
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Telephone | 847-742-5070
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Fax | 847-742-3121
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Authorized Official
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Title or Position | OWNER
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Name | MR. STEVEN KELLENBERGER
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Credential | DC
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Telephone | 847-742-5070
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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 | 038006969
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License Number State | IL
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