Provider Demographics
NPI:1134257405
Name:MIRANTE, KEITH WILLIAM (DC)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:WILLIAM
Last Name:MIRANTE
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 1:15 MEIGS AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-3057
Mailing Address - Country:US
Mailing Address - Phone:203-245-8217
Mailing Address - Fax:203-245-9390
Practice Address - Street 1:15 MEIGS AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-3057
Practice Address - Country:US
Practice Address - Phone:203-245-8217
Practice Address - Fax:203-245-9390
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001711111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD10001148Medicare PIN