Provider Demographics
NPI:1275758740
Name:WALBURN, KEITH JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:JOSEPH
Last Name:WALBURN
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 1:3940 RADIO RD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-3740
Mailing Address - Country:US
Mailing Address - Phone:239-261-9199
Mailing Address - Fax:239-261-9399
Practice Address - Street 1:3940 RADIO RD
Practice Address - Street 2:105
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-3740
Practice Address - Country:US
Practice Address - Phone:239-261-9199
Practice Address - Fax:239-261-9399
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004838111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology