Provider Demographics
NPI:1568512689
Name:KEY WEST CHIROPRACTIC HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:KEY WEST CHIROPRACTIC HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:REBECCA
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-588-9776
Mailing Address - Street 1:2254 FLINT HILL DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52003-8097
Mailing Address - Country:US
Mailing Address - Phone:563-588-9776
Mailing Address - Fax:563-588-8972
Practice Address - Street 1:2254 FLINT HILL DR
Practice Address - Street 2:SUITE 1
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52003-8097
Practice Address - Country:US
Practice Address - Phone:563-588-9776
Practice Address - Fax:563-588-8972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06098111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3117681Medicaid
IA42687Medicare PIN
IA3117681Medicaid
T00293Medicare UPIN