Provider Demographics
NPI:1225192982
Name:KEILMAN, GREGORY LEO (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:LEO
Last Name:KEILMAN
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 1:113 E 2ND ST SUITE A
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058
Mailing Address - Country:US
Mailing Address - Phone:541-296-8991
Mailing Address - Fax:
Practice Address - Street 1:113 E 2ND ST SUITE A
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058
Practice Address - Country:US
Practice Address - Phone:541-296-8991
Practice Address - Fax:541-296-8995
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR272785111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor