Provider Demographics
NPI:1134162217
Name:KEEBLER, BENJAMIN DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:DAVID
Last Name:KEEBLER
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 1:100 GREENBRAIR DR
Mailing Address - Street 2:
Mailing Address - City:KERSEY
Mailing Address - State:PA
Mailing Address - Zip Code:15846
Mailing Address - Country:US
Mailing Address - Phone:814-834-6053
Mailing Address - Fax:
Practice Address - Street 1:1194 MILLON DOLLAR HIGHWAY
Practice Address - Street 2:
Practice Address - City:KERSEY
Practice Address - State:PA
Practice Address - Zip Code:15846
Practice Address - Country:US
Practice Address - Phone:814-834-6056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008994111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAKE1465170OtherBCBS
PAKE1465170OtherBCBS