Provider Demographics
NPI:1629676549
Name:KEATS FAMILY & SPORTS CHIROPRACTIC
Entity Type:Organization
Organization Name:KEATS FAMILY & SPORTS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-230-2554
Mailing Address - Street 1:1999 S MAIN ST STE 303
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-6601
Mailing Address - Country:US
Mailing Address - Phone:540-739-3833
Mailing Address - Fax:
Practice Address - Street 1:1999 S MAIN ST STE 303
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-6601
Practice Address - Country:US
Practice Address - Phone:540-739-3833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty