Provider Demographics
NPI:1558686386
Name:KINSLEY, KEITH S (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:S
Last Name:KINSLEY
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 1:346A NORTHEAST BLVD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328
Mailing Address - Country:US
Mailing Address - Phone:910-592-1115
Mailing Address - Fax:910-592-1541
Practice Address - Street 1:346A NORTHEAST BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328
Practice Address - Country:US
Practice Address - Phone:910-592-1115
Practice Address - Fax:910-592-1541
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3983111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5916173Medicaid
NC2458079Medicare PIN