Provider Demographics
NPI:1154735256
Name:SMITH, KEELEY (DC)
Entity type:Individual
Prefix:DR
First Name:KEELEY
Middle Name:
Last Name:SMITH
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 1:612 5TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-2426
Mailing Address - Country:US
Mailing Address - Phone:712-229-1582
Mailing Address - Fax:
Practice Address - Street 1:1001 HUDSON ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-2304
Practice Address - Country:US
Practice Address - Phone:319-277-5616
Practice Address - Fax:319-277-0355
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA074275111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor