Provider Demographics
NPI:1205027877
Name:KEYS CHIROPRACTIC, P. C.
Entity Type:Organization
Organization Name:KEYS CHIROPRACTIC, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KEYS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:260-420-8803
Mailing Address - Street 1:2422 LAKE AVE
Mailing Address - Street 2:PARK LAKE MEDICAL BLDG
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-5406
Mailing Address - Country:US
Mailing Address - Phone:260-420-8803
Mailing Address - Fax:260-420-6814
Practice Address - Street 1:2422 LAKE AVE
Practice Address - Street 2:PARK LAKE MEDICAL BLDG
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5406
Practice Address - Country:US
Practice Address - Phone:260-420-8803
Practice Address - Fax:260-420-6814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001845A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN152800OtherMEDICARE
IN0000190008OtherBCBS