Provider Demographics
NPI:1225370240
Name:KEIM, RICHARD L (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:KEIM
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 1:2424 PEDDLERS VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46528-5778
Mailing Address - Country:US
Mailing Address - Phone:574-533-0815
Mailing Address - Fax:574-533-0815
Practice Address - Street 1:2424 PEDDLERS VILLAGE RD
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46528-5778
Practice Address - Country:US
Practice Address - Phone:574-533-0815
Practice Address - Fax:574-533-0815
Is Sole Proprietor?:No
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000562A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN226720AMedicare PIN
MA226720Medicare Oscar/Certification
INU12316Medicare UPIN