Provider Demographics
NPI:1851712327
Name:KELLER, LAUREN M (DC)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:M
Last Name:KELLER
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 1:1449 W LAKE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-1869
Mailing Address - Country:US
Mailing Address - Phone:260-415-8357
Mailing Address - Fax:
Practice Address - Street 1:1449 W LAKE ST
Practice Address - Street 2:SUITE B
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-1869
Practice Address - Country:US
Practice Address - Phone:260-415-8357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-30
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012564111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor