Provider Demographics
NPI:1295013845
Name:KEITH WELLNESS & REHABILITATION CENTER, P.A.
Entity Type:Organization
Organization Name:KEITH WELLNESS & REHABILITATION CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:ESTRAMONTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-941-6000
Mailing Address - Street 1:4024 TRIANGLE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-2828
Mailing Address - Country:US
Mailing Address - Phone:704-941-6000
Mailing Address - Fax:704-941-6001
Practice Address - Street 1:4024 TRIANGLE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-2828
Practice Address - Country:US
Practice Address - Phone:704-941-6000
Practice Address - Fax:704-941-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4184111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
54937BMedicare UPIN