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General NPI Number Information
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NPI Number | 1932264900
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC INJURY CENTER, LLC
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 199 SHIRLEY AVE
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City | REVERE
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State | MA
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Zip | 02151-3258
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Country | US
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Telephone | 781-485-3801
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Fax |
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Provider Business Mailing Address
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Address Line | 199 SHIRLEY AVE
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City | REVERE
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State | MA
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Zip | 02151-3258
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DR. JEFFREY KELLER
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Name | JEFFREY I KELLER
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Credential | D.C.
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Telephone | 781-485-3801
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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 | 2403
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License Number State | MA
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