MEDICARE: DR. DOUGLAS PAUL KELLERMAN 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
1	111N00000X	Chiropractor	8001	FL

General Provider Information

NPI Number	:	1194863100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS PAUL KELLERMAN D.C.

Provider Business Mailing Address
First Line	:	410 NE 44TH ST
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33334-1423
Country	:	US
Telephone Number	:	954-561-4700
Fax Number	:	954-561-0812

Provider Business Practice Location Address
First Line	:	410 NE 44TH ST
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33334-1423
Country	:	US
Telephone Number	:	954-561-4700
Fax Number	:	954-561-0812

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	01/25/2017

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