Provider Demographics
NPI:1326169541
Name:VANTERPOOL, KEITA L (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITA
Middle Name:L
Last Name:VANTERPOOL
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:PO BOX 30276
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20030-0276
Mailing Address - Country:US
Mailing Address - Phone:202-744-3430
Mailing Address - Fax:202-536-2478
Practice Address - Street 1:2300 GOOD HOPE RD SE APT 916
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-5132
Practice Address - Country:US
Practice Address - Phone:202-744-3430
Practice Address - Fax:202-536-2478
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCH30018111N00000X, 174400000X
MDSO3383111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No111N00000XChiropractic ProvidersChiropractor