Provider Demographics
NPI:1023298080
Name:EVERMAN, KEITH M (DC)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:M
Last Name:EVERMAN
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 1:806 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:BAY ST LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39520-2701
Mailing Address - Country:US
Mailing Address - Phone:228-463-1778
Mailing Address - Fax:228-463-1423
Practice Address - Street 1:806 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:BAY ST LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520-2701
Practice Address - Country:US
Practice Address - Phone:228-463-1778
Practice Address - Fax:228-463-1423
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS847111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor