Provider Demographics
NPI:1720228539
Name:KEYSTONE CHIROPRACTIC INC
Entity Type:Organization
Organization Name:KEYSTONE CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JINNIFER
Authorized Official - Middle Name:MELISSA
Authorized Official - Last Name:STEPHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-473-9777
Mailing Address - Street 1:330A S LAWRENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:KEYSTONE HEIGHTS
Mailing Address - State:FL
Mailing Address - Zip Code:32656-9219
Mailing Address - Country:US
Mailing Address - Phone:352-473-9777
Mailing Address - Fax:352-473-9777
Practice Address - Street 1:330A S LAWRENCE BLVD
Practice Address - Street 2:
Practice Address - City:KEYSTONE HEIGHTS
Practice Address - State:FL
Practice Address - Zip Code:32656-9219
Practice Address - Country:US
Practice Address - Phone:352-473-9777
Practice Address - Fax:352-473-9777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9215111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty