MEDICARE: SUMMIT CHIROPRACTIC 3

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1962569350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT CHIROPRACTIC 3

Provider Business Mailing Address
First Line	:	1791 S 8TH ST STE F
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-1969
Country	:	US
Telephone Number	:	719-471-2099
Fax Number	:

Provider Business Practice Location Address
First Line	:	1791 S 8TH ST STE F
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-1969
Country	:	US
Telephone Number	:	719-471-2099
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DR. JEFFREY JAY KELLER
Credential	:	D.C.
Telephone Number	:	719-471-2099

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	08/22/2020

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