MEDICARE: KELLERMAN FAMILY CHIROPRACTIC INC

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	CH8001	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	53928	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1750468195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KELLERMAN FAMILY CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	410 E PROSPECT RD
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33334-2970
Country	:	US
Telephone Number	:	954-561-4700
Fax Number	:	954-561-0812

Provider Business Practice Location Address
First Line	:	410 E PROSPECT RD
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	:	PRESIDENT
Name	:	DR. DOUGLAS KELLERMAN
Credential	:	DC
Telephone Number	:	561-296-8484

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	01/30/2017

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