Provider Demographics
NPI:1679830921
Name:KEITH, LAUREN BROOKE (DC)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:BROOKE
Last Name:KEITH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 HIGHDALE CT
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2158
Mailing Address - Country:US
Mailing Address - Phone:214-298-4412
Mailing Address - Fax:
Practice Address - Street 1:1624 HIGHDALE CT
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2158
Practice Address - Country:US
Practice Address - Phone:214-298-4412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11616111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor