Provider Demographics
NPI:1689768657
Name:KELLER, KATHERINE DEE (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:DEE
Last Name:KELLER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KATHERINE
Other - Middle Name:DEE
Other - Last Name:KIKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 52
Mailing Address - Street 2:204 E MAIN ST
Mailing Address - City:LLANO
Mailing Address - State:TX
Mailing Address - Zip Code:78643
Mailing Address - Country:US
Mailing Address - Phone:325-247-2155
Mailing Address - Fax:325-247-2155
Practice Address - Street 1:204 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LLANO
Practice Address - State:TX
Practice Address - Zip Code:78643-2061
Practice Address - Country:US
Practice Address - Phone:325-247-2155
Practice Address - Fax:325-247-2155
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7016111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U62355Medicare UPIN
TX605497Medicare ID - Type Unspecified