Provider Demographics
NPI:1184331951
Name:KEITH CLINIC ESTRAMONTE CHIROPRACTIC GASTONIA PA
Entity type:Organization
Organization Name:KEITH CLINIC ESTRAMONTE CHIROPRACTIC GASTONIA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-420-4690
Mailing Address - Street 1:405 N CHESTER ST
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-7396
Mailing Address - Country:US
Mailing Address - Phone:704-838-9447
Mailing Address - Fax:
Practice Address - Street 1:405 N CHESTER ST
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-7396
Practice Address - Country:US
Practice Address - Phone:704-838-9447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-01
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty