Provider Demographics
NPI:1164628707
Name:KELLER, JOY (DACM, LAC, DIPLOM)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:KELLER
Suffix:
Gender:F
Credentials:DACM, LAC, DIPLOM
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 6143
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29903-6143
Mailing Address - Country:US
Mailing Address - Phone:843-486-2803
Mailing Address - Fax:
Practice Address - Street 1:1100 RIBAUT RD STE 2B
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-8007
Practice Address - Country:US
Practice Address - Phone:843-486-2803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10598171100000X
SC382171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA04-3839819OtherEIN TAX ID