Healthcare Provider Details

I. General information

NPI: 1770400509
Provider Name (Legal Business Name): KEEL SPINE & PERFORMANCE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 STERLING PLAZA DR STE 406
PONTE VEDRA FL
32081-8562
US

IV. Provider business mailing address

632 BATTLEGATE LN
PONTE VEDRA FL
32081-7033
US

V. Phone/Fax

Practice location:
  • Phone: 860-946-7262
  • Fax:
Mailing address:
  • Phone: 860-946-7262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: NOLAN GALLAGHER
Title or Position: OWNER, FOUNDER, MGR
Credential: DC
Phone: 860-946-7262