1528122231 NPI number — STEVEN J KELLER, D.C, P.A.

Table of content: (NPI 1528122231)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528122231 NPI number — STEVEN J KELLER, D.C, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEVEN J KELLER, D.C, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528122231
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1920 WASHINGTON ST
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
CAMDEN
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71701-3134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-836-9999
Provider Business Mailing Address Fax Number:
870-836-9998

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1920 W WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CAMDEN
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71701-3134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-836-9999
Provider Business Practice Location Address Fax Number:
870-836-9998
Provider Enumeration Date:
12/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KELLER
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
870-836-9999

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1525 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 350054692 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 145598718 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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