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NPI Code Detail

MEDICARE: DR. KELLY LEE KETZ D.C.

MEDICARE: DR. KELLY LEE KETZ D.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor356AK

General Provider Information

NPI Number : 1164564415
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KELLY LEE KETZ D.C.
Provider Business Mailing Address
First Line : 5905 LAKE OTIS PKWY STE B
Second Line :
City : ANCHORAGE
State : AK
Zip : 99507-1700
Country : US
Telephone Number : 907-562-5500
Fax Number :
Provider Business Practice Location Address
First Line : 5905 LAKE OTIS PKWY STE B
Second Line :
City : ANCHORAGE
State : AK
Zip : 99507
Country : US
Telephone Number : 907-562-5500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2007
Last Update Date : 08/27/2018

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