Provider Demographics
NPI:1457776601
Name:KEYSTONE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:KEYSTONE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:TOWNE
Authorized Official - Suffix:I
Authorized Official - Credentials:DC
Authorized Official - Phone:317-760-3346
Mailing Address - Street 1:10246 ORCHARD PARK DR W
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46280-1519
Mailing Address - Country:US
Mailing Address - Phone:317-760-3346
Mailing Address - Fax:
Practice Address - Street 1:10246 ORCHARD PARK DR W
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46280-1519
Practice Address - Country:US
Practice Address - Phone:317-760-3346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002760A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty