Provider Demographics
NPI:1962569350
Name:SUMMIT CHIROPRACTIC 3
Entity type:Organization
Organization Name:SUMMIT CHIROPRACTIC 3
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-471-2099
Mailing Address - Street 1:1791 S 8TH ST STE F
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-1969
Mailing Address - Country:US
Mailing Address - Phone:719-471-2099
Mailing Address - Fax:
Practice Address - Street 1:1791 S 8TH ST STE F
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-1969
Practice Address - Country:US
Practice Address - Phone:719-471-2099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO524498Medicare ID - Type Unspecified