MEDICARE: MELINDA C 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	X002968-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P2103354	OTHER	NY	OXFORD
2	X7P121	OTHER	NY	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	5897420	OTHER	NY	GHI
5	100063047901	OTHER	NY	AMERICHOICE
6	166252	OTHER	NY	ELDERPLAN

General Provider Information

NPI Number	:	1972550887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELINDA C KELLER DC

Provider Business Mailing Address
First Line	:	5911 16TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-2114
Country	:	US
Telephone Number	:	718-234-6200
Fax Number	:	718-234-6210

Provider Business Practice Location Address
First Line	:	5911 16TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-2114
Country	:	US
Telephone Number	:	718-234-6200
Fax Number	:	718-234-6210

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

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	10/09/2012

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Directions to “ MELINDA C KELLER DC” Practice Location

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