Provider Demographics
NPI:1972550887
Name:KELLER, MELINDA C (DC)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:C
Last Name:KELLER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5911 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-2114
Mailing Address - Country:US
Mailing Address - Phone:718-234-6200
Mailing Address - Fax:718-234-6210
Practice Address - Street 1:5911 16TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-2114
Practice Address - Country:US
Practice Address - Phone:718-234-6200
Practice Address - Fax:718-234-6210
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX002968-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP2103354OtherOXFORD
NYX7P121OtherBLUE CROSS BLUE SHIELD
NY02568041Medicaid
NY5897420OtherGHI
NY100063047901OtherAMERICHOICE
NY166252OtherELDERPLAN
NY166252OtherELDERPLAN
NY02568041Medicaid