Provider Demographics
NPI:1609227115
Name:ACOSTA, KEITH MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:MICHAEL
Last Name:ACOSTA
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 1:73 E FORREST AVE STE 140-E
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17361-1406
Mailing Address - Country:US
Mailing Address - Phone:717-942-2603
Mailing Address - Fax:717-942-2864
Practice Address - Street 1:73 E FORREST AVE STE 140-E
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:PA
Practice Address - Zip Code:17361-1406
Practice Address - Country:US
Practice Address - Phone:717-942-2603
Practice Address - Fax:717-942-2864
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03886111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor