Provider Demographics
NPI:1114301215
Name:KEITH KINSLEY CHIROPRACTIC INCORPORATED
Entity Type:Organization
Organization Name:KEITH KINSLEY CHIROPRACTIC INCORPORATED
Other - Org Name:KELLY CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:KINSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-592-1115
Mailing Address - Street 1:PO BOX 1843
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28329-1843
Mailing Address - Country:US
Mailing Address - Phone:910-592-1115
Mailing Address - Fax:910-592-1541
Practice Address - Street 1:346A NORTHEAST BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328
Practice Address - Country:US
Practice Address - Phone:910-592-1115
Practice Address - Fax:910-592-1541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3983111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5916173Medicaid