Individual
DR. JUSTIN D KELLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
3510 12TH ST, 200, LEWISTON, ID 83501-5575
(208) 799-3333
(208) 799-3375
Mailing address
18919 DOUBLE T LN, LENORE, ID 83541-6088
(208) 816-3365
(208) 799-3375
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA-1739
ID
111NS0005X
Sports Physician Chiropractor
CHIN-1718
ID
Other
Enumeration date
07/11/2016
Last updated
09/28/2016
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