Provider Demographics
NPI:1003878695
Name:LISTON, KEITH A (DC)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:A
Last Name:LISTON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:DUNBAR
Mailing Address - State:PA
Mailing Address - Zip Code:15431-2307
Mailing Address - Country:US
Mailing Address - Phone:419-308-8786
Mailing Address - Fax:419-308-8786
Practice Address - Street 1:1105 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:DUNBAR
Practice Address - State:PA
Practice Address - Zip Code:15431-2307
Practice Address - Country:US
Practice Address - Phone:419-308-8786
Practice Address - Fax:419-308-8786
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008903111N00000X
AZ8230111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU93460Medicare UPIN