Provider Demographics
NPI:1336267046
Name:DELAP, KEITH I (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:I
Last Name:DELAP
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 1:3263 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-1605
Mailing Address - Country:US
Mailing Address - Phone:248-673-6400
Mailing Address - Fax:248-674-0711
Practice Address - Street 1:3263 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-1605
Practice Address - Country:US
Practice Address - Phone:248-673-6400
Practice Address - Fax:248-674-0711
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI004770111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950F35216Medicare UPIN
MIU30855Medicare ID - Type UnspecifiedCHIROPRACTOR