Provider Demographics
NPI:1164801908
Name:COLLETT, KEELEY (DC)
Entity Type:Individual
Prefix:DR
First Name:KEELEY
Middle Name:
Last Name:COLLETT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MALL BLVD
Mailing Address - Street 2:STE 1C
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-4861
Mailing Address - Country:US
Mailing Address - Phone:912-429-5966
Mailing Address - Fax:
Practice Address - Street 1:400 MALL BLVD
Practice Address - Street 2:STE 1C
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-4861
Practice Address - Country:US
Practice Address - Phone:912-429-5966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009504111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor