Provider Demographics
NPI:1467500579
Name:WESTENDORF, KEITH DALE (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:DALE
Last Name:WESTENDORF
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 1:111 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DESHLER
Mailing Address - State:OH
Mailing Address - Zip Code:43516-1159
Mailing Address - Country:US
Mailing Address - Phone:419-278-0517
Mailing Address - Fax:419-278-0517
Practice Address - Street 1:111 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DESHLER
Practice Address - State:OH
Practice Address - Zip Code:43516-1159
Practice Address - Country:US
Practice Address - Phone:419-278-0517
Practice Address - Fax:419-278-0517
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH617111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHWE0431031Medicare ID - Type Unspecified