Provider Demographics
NPI:1245412139
Name:KEYS SPINAL DECOMPRESSION OF KEY WEST LLC
Entity Type:Organization
Organization Name:KEYS SPINAL DECOMPRESSION OF KEY WEST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:FELTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-743-0039
Mailing Address - Street 1:5800 OVERSEAS HWY
Mailing Address - Street 2:SUITE 7
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050
Mailing Address - Country:US
Mailing Address - Phone:305-743-0039
Mailing Address - Fax:
Practice Address - Street 1:3712 N ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4533
Practice Address - Country:US
Practice Address - Phone:305-295-9755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FELTS CHIROPRACTIC CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALCH9362111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty