Provider Demographics
NPI:1962468439
Name:PURI, KEITH M (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:M
Last Name:PURI
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 1:406 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-6700
Mailing Address - Country:US
Mailing Address - Phone:781-488-3388
Mailing Address - Fax:781-488-3363
Practice Address - Street 1:403 BELMONT ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-1019
Practice Address - Country:US
Practice Address - Phone:508-425-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2830111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY36964OtherBLUECROSS/BLUESHIELD
MAAA47417OtherHARVARD PILGRIM
MAU96047Medicare ID - Type Unspecified