Provider Demographics
NPI:1528015898
Name:POPOVICH, KEITH R (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:R
Last Name:POPOVICH
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 1:4100 LIBERTY WAY
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:PA
Mailing Address - Zip Code:15037-3016
Mailing Address - Country:US
Mailing Address - Phone:412-673-0990
Mailing Address - Fax:412-673-0993
Practice Address - Street 1:4100 LIBERTY WAY
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:PA
Practice Address - Zip Code:15037-3016
Practice Address - Country:US
Practice Address - Phone:412-673-0990
Practice Address - Fax:412-673-0993
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009125111N00000X
PAAS008951111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
089337Medicare ID - Type Unspecified