Provider Demographics
NPI:1134513328
Name:KEYSTONE HEALING ARTS CENTER PLLC
Entity Type:Organization
Organization Name:KEYSTONE HEALING ARTS CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:STANSBURY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-896-8715
Mailing Address - Street 1:8522 SIX FORKS RD STE 101
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3098
Mailing Address - Country:US
Mailing Address - Phone:919-896-8715
Mailing Address - Fax:919-896-8698
Practice Address - Street 1:8522 SIX FORKS RD STE 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3098
Practice Address - Country:US
Practice Address - Phone:919-896-8715
Practice Address - Fax:919-896-8698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center