Provider Demographics
NPI:1841428794
Name:MIDDLE KEYS CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:MIDDLE KEYS CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:VAN HOUTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-302-3346
Mailing Address - Street 1:5701 OVERSEAS HWY
Mailing Address - Street 2:SUITE 11
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050-2784
Mailing Address - Country:US
Mailing Address - Phone:305-302-3346
Mailing Address - Fax:
Practice Address - Street 1:5701 OVERSEAS HWY
Practice Address - Street 2:SUITE 11
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-2784
Practice Address - Country:US
Practice Address - Phone:305-302-3346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9531111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
35ZCHBLOtherMEDICARE ID
35ZCHBLOtherMEDICARE ID