Provider Demographics
NPI:1437325735
Name:KEEBLER CHIROPRACTIC PC
Entity Type:Organization
Organization Name:KEEBLER CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:KEEBLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-834-6056
Mailing Address - Street 1:100 GREENBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:KERSEY
Mailing Address - State:PA
Mailing Address - Zip Code:15846-2908
Mailing Address - Country:US
Mailing Address - Phone:814-834-6056
Mailing Address - Fax:814-834-1594
Practice Address - Street 1:1194 MILLION DOLLAR HIGHWAY
Practice Address - Street 2:
Practice Address - City:KERSEY
Practice Address - State:PA
Practice Address - Zip Code:15846
Practice Address - Country:US
Practice Address - Phone:814-834-6056
Practice Address - Fax:814-834-1594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008994111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA069258RPUMedicare PIN