Provider Demographics
NPI:1225106412
Name:KEYSTONE CHIROPRACTIC
Entity Type:Organization
Organization Name:KEYSTONE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFRIES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-987-1234
Mailing Address - Street 1:17039 KENTON DR.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-5642
Mailing Address - Country:US
Mailing Address - Phone:704-987-1234
Mailing Address - Fax:704-987-1238
Practice Address - Street 1:17039 KENTON DR.
Practice Address - Street 2:SUITE 102
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-5642
Practice Address - Country:US
Practice Address - Phone:704-987-1234
Practice Address - Fax:704-987-1238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3454111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty