Provider Demographics
NPI:1114241312
Name:KEETER, ELIZABETH ANNE (DC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNE
Last Name:KEETER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 ROANOKE RD
Mailing Address - Street 2:
Mailing Address - City:DALEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24083-2935
Mailing Address - Country:US
Mailing Address - Phone:907-841-1495
Mailing Address - Fax:540-966-0921
Practice Address - Street 1:1450 ROANOKE RD
Practice Address - Street 2:
Practice Address - City:DALEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24083-2935
Practice Address - Country:US
Practice Address - Phone:540-966-0920
Practice Address - Fax:844-777-1745
Is Sole Proprietor?:No
Enumeration Date:2010-03-17
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK43111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1000772Medicaid
K163013OtherMEDICARE PTAN