Provider Demographics
NPI:1538300108
Name:KATHRYN L KEITH,BS,DC,PC
Entity Type:Organization
Organization Name:KATHRYN L KEITH,BS,DC,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:KEITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:915-833-7797
Mailing Address - Street 1:6955 N MESA ST
Mailing Address - Street 2:STE 302C
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-4442
Mailing Address - Country:US
Mailing Address - Phone:915-833-7797
Mailing Address - Fax:915-833-7239
Practice Address - Street 1:6955 N MESA ST
Practice Address - Street 2:STE 302C
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-4442
Practice Address - Country:US
Practice Address - Phone:915-833-7797
Practice Address - Fax:915-833-7239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4346111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
601771Medicare PIN
TXT14143Medicare UPIN