Provider Demographics
NPI:1255495818
Name:KEYSER, JACK D (DC)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:D
Last Name:KEYSER
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 1:1935 S PLUM GROVE RD # 363
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-7258
Mailing Address - Country:US
Mailing Address - Phone:847-397-6975
Mailing Address - Fax:
Practice Address - Street 1:504 N PLUM GROVE RD
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-8207
Practice Address - Country:US
Practice Address - Phone:847-934-3738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation