Thaddeus Keklak, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

DC011478 Issued in PA

Practice address

911 Anderson St
Bristol, TN 37620-2105

Phone

(423) 764-2663

Fax

(423) 793-1100

NPI assigned

Jun 7, 2019

Last updated

May 16, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Specialty

Chiropractic

Education

New York Chiropractic College, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Tristar Spine and Sport Chiropractic LLC

  • Chiropractor
  • Bristol, TN
  • NPI 1629827159
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1559865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715817600000",
    "number": "1962061671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 ANDERSON ST",
            "city": "BRISTOL",
            "state": "TN",
            "postal_code": "376202105",
            "telephone_number": "423-764-2663",
            "fax_number": "423-793-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 ANDERSON ST",
            "city": "BRISTOL",
            "state": "TN",
            "postal_code": "376202105",
            "telephone_number": "423-764-2663",
            "fax_number": "423-793-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEKLAK",
        "first_name": "THADDEUS",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-07",
        "last_updated": "2024-05-16",
        "certification_date": "2024-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "PA",
            "license": "DC011478",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@elitesportsandspine.com",
            "affiliation": "N",
            "address_1": "2656 Wilmington Rd",
            "city": "New Castle",
            "state": "PA",
            "country_code": "US",
            "postal_code": "161051547",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Timothy Keith Kaney, CRNA
• Parag Kanitkar, OD
• Carina Ingeborg Karlsson, BS-OT
• Monica Kaylor
• Kasey D Keel, PA-C
• Hannah Keller, MD
• Roger Dale Keller, DDS
• Aaron Allen Kelley
• Evelyn C Kemp, PSY.D
• Christopher J Kennedy, MD

• Chiropractor in Bristol, TN
• Providers in Bristol, TN by specialty
• Chiropractor in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.