MEDICARE: KARL THOMAS 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	1669012	WI

General Provider Information

NPI Number	:	1962515999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARL THOMAS KELLER DC

Provider Business Mailing Address
First Line	:	4060 N MAIN ST
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53402-3121
Country	:	US
Telephone Number	:	262-639-2210
Fax Number	:	262-639-4495

Provider Business Practice Location Address
First Line	:	4060 N MAIN ST
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53402-3121
Country	:	US
Telephone Number	:	262-639-2210
Fax Number	:	262-639-4495

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

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	07/08/2007

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Directions to “ KARL THOMAS KELLER DC” Practice Location

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