Provider Demographics
NPI:1003909409
Name:KEITH, ANDREW J (DC)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
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 1:2361 S AZUSA AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-1537
Mailing Address - Country:US
Mailing Address - Phone:626-965-2334
Mailing Address - Fax:626-964-6504
Practice Address - Street 1:2361 S AZUSA AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-1537
Practice Address - Country:US
Practice Address - Phone:626-965-2334
Practice Address - Fax:626-964-6504
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA015972111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT18200Medicare UPIN
CADC15972BMedicare ID - Type Unspecified