Provider Demographics
NPI:1619008422
Name:KEELS, STAFFORD VIRGIL (DC)
Entity Type:Individual
Prefix:DR
First Name:STAFFORD
Middle Name:VIRGIL
Last Name:KEELS
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 1:4 BAYSWATER RD
Mailing Address - Street 2:13 KINGS RD
Mailing Address - City:QUINBY
Mailing Address - State:SC
Mailing Address - Zip Code:29506-7400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 PENNSYLVANIA AVE SE
Practice Address - Street 2:SUITE 100
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-4316
Practice Address - Country:US
Practice Address - Phone:202-544-0577
Practice Address - Fax:202-544-0578
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCH030047111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor