Provider Demographics
NPI:1952137416
Name:KELLER, DEAN (DAOM)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:KELLER
Suffix:
Gender:M
Credentials:DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 11TH AVE STE B
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-4324
Mailing Address - Country:US
Mailing Address - Phone:303-601-0576
Mailing Address - Fax:
Practice Address - Street 1:512 11TH AVE STE B
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-4324
Practice Address - Country:US
Practice Address - Phone:303-601-0576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1094171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist