Provider Demographics
NPI:1922033216
Name:KEITH, COURTLAND D (DC)
Entity Type:Individual
Prefix:DR
First Name:COURTLAND
Middle Name:D
Last Name:KEITH
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 1:7800 MEANY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-5014
Mailing Address - Country:US
Mailing Address - Phone:661-679-7902
Mailing Address - Fax:661-397-6644
Practice Address - Street 1:7800 MEANY AVE STE B
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308
Practice Address - Country:US
Practice Address - Phone:661-679-7902
Practice Address - Fax:661-829-0608
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25723111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00194030Medicare ID - Type Unspecified
CADC025723Medicare ID - Type Unspecified