Provider Demographics
NPI:1144291006
Name:KELTON, BARRY THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:THOMAS
Last Name:KELTON
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 1:890 W POPLAR AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-6505
Mailing Address - Country:US
Mailing Address - Phone:901-853-0103
Mailing Address - Fax:901-853-0049
Practice Address - Street 1:890 W POPLAR AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-6505
Practice Address - Country:US
Practice Address - Phone:901-853-0103
Practice Address - Fax:901-853-0049
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN678111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3676383OtherMEDICARE PTAN
TN3676383OtherMEDICARE PTAN