Provider Demographics
NPI:1831136415
Name:FREDERICK, KEITH A (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:A
Last Name:FREDERICK
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 1:1305 WHEATLAND DR
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-5667
Mailing Address - Country:US
Mailing Address - Phone:620-663-8300
Mailing Address - Fax:620-662-8300
Practice Address - Street 1:1305 WHEATLAND DR
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-5667
Practice Address - Country:US
Practice Address - Phone:620-662-8300
Practice Address - Fax:620-662-8304
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04513111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS060883Medicare ID - Type Unspecified