Provider Demographics
NPI:1154631570
Name:KEITH W. FADY,D.C.P.A.
Entity Type:Organization
Organization Name:KEITH W. FADY,D.C.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:FADY
Authorized Official - Suffix:
Authorized Official - Credentials:DCPA
Authorized Official - Phone:727-596-1885
Mailing Address - Street 1:14100 WALSINGHAM RD
Mailing Address - Street 2:SUITE 35
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-3248
Mailing Address - Country:US
Mailing Address - Phone:727-596-1885
Mailing Address - Fax:727-596-2434
Practice Address - Street 1:14100 WALSINGHAM RD
Practice Address - Street 2:SUITE 35
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-3248
Practice Address - Country:US
Practice Address - Phone:727-596-1885
Practice Address - Fax:727-596-2434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-19
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4297111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty