Provider Demographics
NPI:1134501729
Name:KEO, MELISA (DC, ATC)
Entity Type:Individual
Prefix:DR
First Name:MELISA
Middle Name:
Last Name:KEO
Suffix:
Gender:F
Credentials:DC, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3441 E CAUSEWAY APPROACH STE D
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-3480
Mailing Address - Country:US
Mailing Address - Phone:985-626-0999
Mailing Address - Fax:
Practice Address - Street 1:3441 E CAUSEWAY APPROACH STE D
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-3480
Practice Address - Country:US
Practice Address - Phone:562-420-5433
Practice Address - Fax:562-420-5434
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-19
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1854111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty