MEDICARE: JASON TODD KELLER D.C.

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	DC0000001516	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3067070	OTHER	TN	CIGNA HEALTHCARE
2	3120562	OTHER	TN	BCBS OF TN

General Provider Information

NPI Number	:	1992707053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON TODD KELLER D.C.

Provider Business Mailing Address
First Line	:	1003 E REELFOOT AVE
Second Line	:	STE 1
City	:	UNION CITY
State	:	TN
Zip	:	38261-5871
Country	:	US
Telephone Number	:	731-885-7700
Fax Number	:	731-885-7704

Provider Business Practice Location Address
First Line	:	1003 E REELFOOT AVE
Second Line	:	STE 1
City	:	UNION CITY
State	:	TN
Zip	:	38261
Country	:	US
Telephone Number	:	731-885-7700
Fax Number	:	731-885-7704

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	04/27/2010

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