Provider Demographics
NPI:1336583830
Name:KLVDC PA
Entity Type:Organization
Organization Name:KLVDC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-775-1800
Mailing Address - Street 1:875 MILITARY TRL STE 208
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-5700
Mailing Address - Country:US
Mailing Address - Phone:561-746-4242
Mailing Address - Fax:561-746-7405
Practice Address - Street 1:875 MILITARY TRL STE 208
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-5700
Practice Address - Country:US
Practice Address - Phone:561-746-4242
Practice Address - Fax:561-746-7405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-26
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty