Provider Demographics
NPI:1891986501
Name:LEVICK, KEITH ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ALLEN
Last Name:LEVICK
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 1:1706 YORK ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BLOOMER
Mailing Address - State:WI
Mailing Address - Zip Code:54724-1920
Mailing Address - Country:US
Mailing Address - Phone:715-568-9923
Mailing Address - Fax:715-568-9924
Practice Address - Street 1:1706 YORK ST
Practice Address - Street 2:SUITE 5
Practice Address - City:BLOOMER
Practice Address - State:WI
Practice Address - Zip Code:54724-1920
Practice Address - Country:US
Practice Address - Phone:715-568-9923
Practice Address - Fax:715-568-9924
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2008-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4151-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU89776Medicare UPIN