Provider Demographics
NPI:1821860263
Name:KEEDY, AVONLEA MALYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:AVONLEA
Middle Name:MALYNN
Last Name:KEEDY
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 1:3542 ASPIRE CIR APT 1214
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-5937
Mailing Address - Country:US
Mailing Address - Phone:724-963-8539
Mailing Address - Fax:
Practice Address - Street 1:20041 S TAMIAMI TRL STE 16
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-2228
Practice Address - Country:US
Practice Address - Phone:724-963-8539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14684111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor