Active NPI
Khristian Kellum, DC
- Chiropractor
- Saint Peters, MO
National Provider Identifier
1932815180
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 2022034414
- Practice address
- 6227 Mid Rivers Mall Dr
Saint Peters, MO 63304-1102 - Phone
- (636) 244-8765
- NPI assigned
- Jan 30, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 2022034414 | MO | Primary |
Addresses
Primary practice location
6227 Mid Rivers Mall Dr
Saint Peters, MO 63304-1102
Mailing address
16526 Lacross LN
Chesterfield, MO 63005-4606
Phone (901) 283-6127
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2022034414 | MO | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1675036800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675036800000",
"number": "1932815180",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16526 LACROSS LN",
"city": "CHESTERFIELD",
"state": "MO",
"postal_code": "630054606",
"telephone_number": "901-283-6127"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6227 MID RIVERS MALL DR",
"city": "SAINT PETERS",
"state": "MO",
"postal_code": "633041102",
"telephone_number": "636-244-8765"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLUM",
"first_name": "KHRISTIAN",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-01-30",
"last_updated": "2023-01-30",
"certification_date": "2023-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MO",
"license": "2022034414",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Peters, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.