Provider Demographics
NPI:1033389481
Name:KELLER, JASON LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:LEE
Last Name:KELLER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 BARNES RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-1564
Mailing Address - Country:US
Mailing Address - Phone:719-597-7206
Mailing Address - Fax:719-597-7864
Practice Address - Street 1:4440 BARNES RD
Practice Address - Street 2:SUITE 200
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-1564
Practice Address - Country:US
Practice Address - Phone:719-597-7206
Practice Address - Fax:719-597-7864
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR-5184111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor