Provider Demographics
NPI:1093784787
Name:KEELER, JAY D (DC)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:D
Last Name:KEELER
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:PO BOX 152
Mailing Address - Street 2:758 E WICHITA AVE
Mailing Address - City:RUSSELL
Mailing Address - State:KS
Mailing Address - Zip Code:67665
Mailing Address - Country:US
Mailing Address - Phone:785-483-4909
Mailing Address - Fax:785-483-5166
Practice Address - Street 1:1700 E 30TH AVE STE A
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-1263
Practice Address - Country:US
Practice Address - Phone:620-662-6607
Practice Address - Fax:620-662-6850
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0104232111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
062050OtherBCBS
P00124639OtherRAILROAD MEDICARE
U50265Medicare UPIN
660061Medicare ID - Type Unspecified