Provider Demographics
NPI:1326159252
Name:KEITH, KATHRYN L (DC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:L
Last Name:KEITH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6955 N MESA ST
Mailing Address - Street 2:STE 302C
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-4442
Mailing Address - Country:US
Mailing Address - Phone:915-833-7797
Mailing Address - Fax:915-833-7239
Practice Address - Street 1:6955 N MESA ST
Practice Address - Street 2:STE 302C
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-4442
Practice Address - Country:US
Practice Address - Phone:915-833-7797
Practice Address - Fax:915-833-7239
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4346111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT14143Medicare UPIN
TX601771Medicare ID - Type Unspecified