Provider Demographics
NPI:1588948269
Name:KELLER, HEIDI JANE (MS, DC)
Entity type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:JANE
Last Name:KELLER
Suffix:
Gender:F
Credentials:MS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:412 RED HILL AVE
Mailing Address - Street 2:STE 11
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-2469
Mailing Address - Country:US
Mailing Address - Phone:415-482-8282
Mailing Address - Fax:415-482-8280
Practice Address - Street 1:412 RED HILL AVE
Practice Address - Street 2:SUITE11
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-2450
Practice Address - Country:US
Practice Address - Phone:415-482-8282
Practice Address - Fax:415-482-8280
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24152111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor