Provider Demographics
NPI:1083795801
Name:KEYSER, BRETT ALAN (DC)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:ALAN
Last Name:KEYSER
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 1:13245 CONNEAUT LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT LAKE
Mailing Address - State:PA
Mailing Address - Zip Code:16316-6809
Mailing Address - Country:US
Mailing Address - Phone:814-382-8840
Mailing Address - Fax:814-382-8840
Practice Address - Street 1:13245 CONNEAUT LAKE RD
Practice Address - Street 2:
Practice Address - City:CONNEAUT LAKE
Practice Address - State:PA
Practice Address - Zip Code:16316-6809
Practice Address - Country:US
Practice Address - Phone:814-382-8840
Practice Address - Fax:814-382-8840
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007703L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017865180003Medicaid
PA340625OtherHIGHMARK BC/BS
PA313675OtherUPMC
U81485Medicare UPIN
PA041034Medicare ID - Type Unspecified