Provider Demographics
NPI:1528105574
Name:KELLENBERGER, DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:KELLENBERGER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3169 PROFESSIONAL PLZ
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-7917
Mailing Address - Country:US
Mailing Address - Phone:901-861-1212
Mailing Address - Fax:901-861-1283
Practice Address - Street 1:3169 PROFESSIONAL PLZ
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-7917
Practice Address - Country:US
Practice Address - Phone:901-861-1212
Practice Address - Fax:901-618-1283
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1490111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN11-3803810OtherTAX IDENTIFICATION
4165737OtherBCBST