Provider Demographics
NPI:1407916851
Name:KRAMER, KEITH ALLAN (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ALLAN
Last Name:KRAMER
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 1:7620 N UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-1297
Mailing Address - Country:US
Mailing Address - Phone:309-693-9600
Mailing Address - Fax:309-693-3616
Practice Address - Street 1:2208 W WILLOW KNOLLS DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-1467
Practice Address - Country:US
Practice Address - Phone:309-693-9600
Practice Address - Fax:309-693-3616
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA038008433111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU72755Medicare UPIN