Provider Demographics
NPI:1669655973
Name:FORD, KEITH C (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:C
Last Name:FORD
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 1:1701 COUNTY RD
Mailing Address - Street 2:STE. L
Mailing Address - City:MINDEN
Mailing Address - State:NV
Mailing Address - Zip Code:89423-4464
Mailing Address - Country:US
Mailing Address - Phone:775-782-1000
Mailing Address - Fax:
Practice Address - Street 1:1701 COUNTY RD
Practice Address - Street 2:STE. L
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-4464
Practice Address - Country:US
Practice Address - Phone:775-782-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV B-321111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003603004Medicaid
USA277820OtherBLUE CROSS/BLUE SHIELD
USA277820OtherBLUE CROSS/BLUE SHIELD
NVU32646Medicare UPIN