Provider Demographics
NPI:1699001370
Name:KEYSTONE CHIROPRACTIC
Entity Type:Organization
Organization Name:KEYSTONE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:T
Authorized Official - Last Name:RAYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:916-452-5055
Mailing Address - Street 1:4250 H ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3441
Mailing Address - Country:US
Mailing Address - Phone:916-452-5055
Mailing Address - Fax:916-452-9325
Practice Address - Street 1:4250 H ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3441
Practice Address - Country:US
Practice Address - Phone:916-452-5055
Practice Address - Fax:916-452-9325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29525111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0295250Medicare PIN