Provider Demographics
NPI:1568524916
Name:KEATON, DANA (NMD LAC)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:KEATON
Suffix:
Gender:F
Credentials:NMD LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 W MCDOWELL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85007-1730
Mailing Address - Country:US
Mailing Address - Phone:602-266-4670
Mailing Address - Fax:602-279-2760
Practice Address - Street 1:906 W MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007-1730
Practice Address - Country:US
Practice Address - Phone:602-266-4670
Practice Address - Fax:602-279-2760
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ90-411175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath