MEDICARE: DR. LAWRENCE JEFFREY KELLER DC

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	CH5317	FL

General Provider Information

NPI Number	:	1649292087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE JEFFREY KELLER DC

Provider Business Mailing Address
First Line	:	5700 LAKE WORTH RD
Second Line	:	SUITE111
City	:	GREENACRES
State	:	FL
Zip	:	33463-4727
Country	:	US
Telephone Number	:	561-729-0502
Fax Number	:	561-729-0589

Provider Business Practice Location Address
First Line	:	5700 LAKE WORTH RD
Second Line	:	SUITE111
City	:	GREENACRES
State	:	FL
Zip	:	33463-4727
Country	:	US
Telephone Number	:	561-729-0502
Fax Number	:	561-729-0589

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	05/20/2011

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