Provider Demographics
NPI:1891077863
Name:MEYER, KEITH DAVID (DC)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:DAVID
Last Name:MEYER
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:PO BOX 484
Mailing Address - Street 2:
Mailing Address - City:QUILCENE
Mailing Address - State:WA
Mailing Address - Zip Code:98376-0484
Mailing Address - Country:US
Mailing Address - Phone:360-477-9757
Mailing Address - Fax:
Practice Address - Street 1:51 OLD CHURCH ROAD
Practice Address - Street 2:
Practice Address - City:QUILCENE
Practice Address - State:WA
Practice Address - Zip Code:98376-0484
Practice Address - Country:US
Practice Address - Phone:360-477-9757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60131354111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor