Provider Demographics
NPI:1467580852
Name:KEIZER CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:KEIZER CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-390-5552
Mailing Address - Street 1:115 MCNARY ESTATES DR N STE E
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-7492
Mailing Address - Country:US
Mailing Address - Phone:503-390-5552
Mailing Address - Fax:503-390-5994
Practice Address - Street 1:115 MCNARY ESTATES DR N STE E
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-7492
Practice Address - Country:US
Practice Address - Phone:503-390-5552
Practice Address - Fax:503-390-5994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2017-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3020111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty