Provider Demographics
NPI:1376557801
Name:HARDOIN, KEITH ALLAN (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ALLAN
Last Name:HARDOIN
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 1:7220 FAIR OAKS BLVD
Mailing Address - Street 2:#B
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-6400
Mailing Address - Country:US
Mailing Address - Phone:916-489-7246
Mailing Address - Fax:916-489-4506
Practice Address - Street 1:7220 FAIR OAKS BLVD
Practice Address - Street 2:#B
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-6400
Practice Address - Country:US
Practice Address - Phone:916-489-7246
Practice Address - Fax:916-489-4506
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0172890111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ28810ZMedicare PIN
CAT06419Medicare ID - Type Unspecified