Provider Demographics
NPI:1619166790
Name:KEIFER CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:KEIFER CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTITIONER / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:KEIFER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:520-577-1717
Mailing Address - Street 1:4431 N SWAN RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-6710
Mailing Address - Country:US
Mailing Address - Phone:520-577-1717
Mailing Address - Fax:520-577-7766
Practice Address - Street 1:4431 N SWAN RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-6710
Practice Address - Country:US
Practice Address - Phone:520-577-1717
Practice Address - Fax:520-577-7766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2095111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ75822Medicare PIN