Provider Demographics
NPI:1932308251
Name:MAINPRIZE, KEITH EDWIN (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:EDWIN
Last Name:MAINPRIZE
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 1:2018 S STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2523
Mailing Address - Country:US
Mailing Address - Phone:417-881-9042
Mailing Address - Fax:417-881-2653
Practice Address - Street 1:2018 S STEWART AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2523
Practice Address - Country:US
Practice Address - Phone:417-881-9042
Practice Address - Fax:417-881-2653
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005885111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000032530Medicare PIN