Provider Demographics
NPI:1881855799
Name:KEIMIG, ALYSSA SMITH (DC)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:SMITH
Last Name:KEIMIG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:KRISTINE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:14038 HAZELWOOD CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-0869
Mailing Address - Country:US
Mailing Address - Phone:443-235-6039
Mailing Address - Fax:904-212-1072
Practice Address - Street 1:983 ATLANTIC BLVD STE 119
Practice Address - Street 2:
Practice Address - City:ATLANTIC BEACH
Practice Address - State:FL
Practice Address - Zip Code:32233-3311
Practice Address - Country:US
Practice Address - Phone:904-203-4983
Practice Address - Fax:904-212-1072
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11590111N00000X
MDS03575111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor