Provider Demographics
NPI:1043722309
Name:CHVATAL, KEITH ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ROBERT
Last Name:CHVATAL
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 1:1909 SUTTON DR
Mailing Address - Street 2:
Mailing Address - City:WAHOO
Mailing Address - State:NE
Mailing Address - Zip Code:68066-4131
Mailing Address - Country:US
Mailing Address - Phone:402-443-9429
Mailing Address - Fax:
Practice Address - Street 1:1320 E 31ST ST
Practice Address - Street 2:
Practice Address - City:WAHOO
Practice Address - State:NE
Practice Address - Zip Code:68066-5581
Practice Address - Country:US
Practice Address - Phone:024-277-7180
Practice Address - Fax:402-277-7182
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-26
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1955111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor