Provider Demographics
NPI:1346269214
Name:GILLASPY, KEITH J (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:J
Last Name:GILLASPY
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 1:6230 JONESTOWN RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-6257
Mailing Address - Country:US
Mailing Address - Phone:717-671-4455
Mailing Address - Fax:717-671-1450
Practice Address - Street 1:6230 JONESTOWN RD
Practice Address - Street 2:SUITE D
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-6257
Practice Address - Country:US
Practice Address - Phone:717-671-4455
Practice Address - Fax:717-671-1450
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004654L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPA665460OtherBLUE SHIELD
PAGI665460Medicare ID - Type Unspecified
PAU17549Medicare UPIN