Provider Demographics
NPI:1285653675
Name:KEITH-MADEIROS, LILLIAN DAWN (DC)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:DAWN
Last Name:KEITH-MADEIROS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 SE BAYSHORE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-4062
Mailing Address - Country:US
Mailing Address - Phone:360-675-1066
Mailing Address - Fax:360-679-2278
Practice Address - Street 1:840 SE BAYSHORE DR SUITE 101
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277
Practice Address - Country:US
Practice Address - Phone:360-675-1066
Practice Address - Fax:360-679-2278
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH0003601111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor