Provider Demographics
NPI:1518011170
Name:KEITH J BISCOTTI CHIROPRACTIC INC
Entity Type:Organization
Organization Name:KEITH J BISCOTTI CHIROPRACTIC INC
Other - Org Name:SOUTH BAY FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BISCOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:619-427-7761
Mailing Address - Street 1:213 LANDIS AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-2608
Mailing Address - Country:US
Mailing Address - Phone:619-427-7761
Mailing Address - Fax:619-427-7795
Practice Address - Street 1:213 LANDIS AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2608
Practice Address - Country:US
Practice Address - Phone:619-427-7761
Practice Address - Fax:619-427-7795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29217111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC29217Medicare ID - Type Unspecified