Provider Demographics
NPI:1861635807
Name:PATEL, KETA (D C)
Entity Type:Individual
Prefix:MRS
First Name:KETA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:D C
Other - Prefix:MRS
Other - First Name:KETA
Other - Middle Name:
Other - Last Name:PATEL-AMIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:16527 LONG LAKE DR
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-4295
Mailing Address - Country:US
Mailing Address - Phone:225-733-1500
Mailing Address - Fax:
Practice Address - Street 1:17900 AIRLINE HWY
Practice Address - Street 2:SUITE A
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3761
Practice Address - Country:US
Practice Address - Phone:225-733-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1473111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation