Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH2118 | FL |
NPI | 1003065202 |
---|---|
Provider Name | Dr. John Howard Kellenberger SR. |
First Address | North Fort Myers, FL 33917-2985 |
Second Address | Fort Myers, FL 33912-4450 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2008 |
Last Update Date | 11/09/2008 |