Provider Demographics
NPI:1770827891
Name:EBNER, KEITH ROY (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ROY
Last Name:EBNER
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 1:102 NORTH STAGHORN LANE
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650
Mailing Address - Country:US
Mailing Address - Phone:864-292-0766
Mailing Address - Fax:
Practice Address - Street 1:150 MILESTONE WAY
Practice Address - Street 2:SUITE A
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6605
Practice Address - Country:US
Practice Address - Phone:864-616-2675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3750111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor