Provider Demographics
NPI:1205078110
Name:KEYSTONE NATURAL HEALTH LLC
Entity type:Organization
Organization Name:KEYSTONE NATURAL HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:717-697-0589
Mailing Address - Street 1:856 CENTURY DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-4505
Mailing Address - Country:US
Mailing Address - Phone:717-697-0589
Mailing Address - Fax:717-697-1700
Practice Address - Street 1:856 CENTURY DR
Practice Address - Street 2:SUITE C
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-4505
Practice Address - Country:US
Practice Address - Phone:717-697-0589
Practice Address - Fax:717-697-1700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC10065111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty