Provider Demographics
NPI:1124186200
Name:HELMENDACH, KEITH THEODORE (DC)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:THEODORE
Last Name:HELMENDACH
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 1:6520 GOLD WAGON LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227
Mailing Address - Country:US
Mailing Address - Phone:704-545-0429
Mailing Address - Fax:704-545-7708
Practice Address - Street 1:7215 LEBANON RD
Practice Address - Street 2:A
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227
Practice Address - Country:US
Practice Address - Phone:704-573-7161
Practice Address - Fax:704-573-7161
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1833111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890850GMedicaid
NC08959OtherBCBS
U242111Medicare UPIN
NC2447207AMedicare ID - Type Unspecified