Provider Demographics
NPI:1609172048
Name:KEYSTONE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:KEYSTONE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:D
Authorized Official - Last Name:INGRUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-270-9993
Mailing Address - Street 1:3322 MEMORIAL PKWY SW
Mailing Address - Street 2:SUITE 617
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5335
Mailing Address - Country:US
Mailing Address - Phone:256-270-9993
Mailing Address - Fax:256-270-9994
Practice Address - Street 1:3322 MEMORIAL PKWY SW
Practice Address - Street 2:SUITE 617
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5335
Practice Address - Country:US
Practice Address - Phone:256-270-9993
Practice Address - Fax:256-270-9994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2253111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty