Provider Demographics
NPI:1689925349
Name:CURCILLO, KEITH D (D,C)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:D
Last Name:CURCILLO
Suffix:
Gender:M
Credentials:D,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4132 KATELLA AVE STE 205B
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-6602
Mailing Address - Country:US
Mailing Address - Phone:562-833-3686
Mailing Address - Fax:562-799-1715
Practice Address - Street 1:4132 KATELLA AVE STE 205B
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-6602
Practice Address - Country:US
Practice Address - Phone:562-833-3686
Practice Address - Fax:562-799-1715
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20558111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor