Provider Demographics
NPI:1114001146
Name:KEITH, DONALD T (DC)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:T
Last Name:KEITH
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 1:6660 80TH ST
Mailing Address - Street 2:SUITE G2
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-2738
Mailing Address - Country:US
Mailing Address - Phone:718-894-4477
Mailing Address - Fax:718-894-7177
Practice Address - Street 1:6660 80TH ST
Practice Address - Street 2:SUITE G2
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-2738
Practice Address - Country:US
Practice Address - Phone:718-894-4477
Practice Address - Fax:718-894-7177
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX00348-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY60031Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NYT32024Medicare UPIN