Provider Demographics
NPI:1528122231
Name:STEVEN J KELLER, D.C, P.A.
Entity type:Organization
Organization Name:STEVEN J KELLER, D.C, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-836-9999
Mailing Address - Street 1:1920 WASHINGTON ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:CAMDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71701-3134
Mailing Address - Country:US
Mailing Address - Phone:870-836-9999
Mailing Address - Fax:870-836-9998
Practice Address - Street 1:1920 W WASHINGTON ST
Practice Address - Street 2:SUITE B
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701-3134
Practice Address - Country:US
Practice Address - Phone:870-836-9999
Practice Address - Fax:870-836-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1525111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR350054692OtherRAILROAD MEDICARE
AR145598718Medicaid
AR350054692OtherRAILROAD MEDICARE
AR5F781Medicare ID - Type UnspecifiedMEDICARE BCBS CLINIC