Provider Demographics
NPI:1851503122
Name:KEYSTONE CHIRO CENTER, LLC
Entity Type:Organization
Organization Name:KEYSTONE CHIRO CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:ELLIS
Authorized Official - Last Name:LORENZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-565-5403
Mailing Address - Street 1:1251 N HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-6785
Mailing Address - Country:US
Mailing Address - Phone:614-475-1900
Mailing Address - Fax:614-475-1920
Practice Address - Street 1:1251 N HAMILTON RD
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-6785
Practice Address - Country:US
Practice Address - Phone:614-475-1900
Practice Address - Fax:614-475-1920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3795111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHLO4207201Medicare PIN
OHMA4207391Medicare PIN
OHV12349Medicare UPIN
OHV12350Medicare UPIN