Provider Demographics
NPI:1588984546
Name:KELLER CHIROPRACTIC
Entity type:Organization
Organization Name:KELLER CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VALARIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-352-4517
Mailing Address - Street 1:104 10TH ST SW
Mailing Address - Street 2:PO BOX 121
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-2924
Mailing Address - Country:US
Mailing Address - Phone:319-352-4517
Mailing Address - Fax:319-352-4518
Practice Address - Street 1:104 10TH ST SW
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-2924
Practice Address - Country:US
Practice Address - Phone:319-352-4517
Practice Address - Fax:319-352-4518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAO6917111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty