Provider Demographics
NPI:1225115025
Name:GIAQUINTO, KEITH ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ANTHONY
Last Name:GIAQUINTO
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 1:640 N RIVER ROAD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563
Mailing Address - Country:US
Mailing Address - Phone:630-548-0700
Mailing Address - Fax:630-548-9070
Practice Address - Street 1:640 N RIVER ROAD
Practice Address - Street 2:SUITE 114
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563
Practice Address - Country:US
Practice Address - Phone:630-548-0700
Practice Address - Fax:630-548-9070
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38009801111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor