Provider Demographics
NPI:1538621040
Name:KELLERMANN CHIROPRACTIC INC
Entity type:Organization
Organization Name:KELLERMANN CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MR
Authorized Official - Phone:224-778-5140
Mailing Address - Street 1:365 SURRYSE RD STE 260
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-2680
Mailing Address - Country:US
Mailing Address - Phone:847-540-7228
Mailing Address - Fax:
Practice Address - Street 1:365 SURRYSE RD STE 260
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-2680
Practice Address - Country:US
Practice Address - Phone:847-540-7228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty