Provider Demographics
NPI:1851498984
Name:BARTLEY, KEITH MARTIN (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:MARTIN
Last Name:BARTLEY
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 1:1201 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-2835
Mailing Address - Country:US
Mailing Address - Phone:812-482-6600
Mailing Address - Fax:812-482-6615
Practice Address - Street 1:1201 MAIN ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-2835
Practice Address - Country:US
Practice Address - Phone:812-482-6600
Practice Address - Fax:812-482-6615
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001246111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN212120Medicare ID - Type Unspecified
INT92799Medicare UPIN