Provider Demographics
NPI:1508954728
Name:SRCH, KEITH ALLAN GLENN (DC)
Entity type:Individual
Prefix:DR
First Name:KEITH ALLAN
Middle Name:GLENN
Last Name:SRCH
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 1:2340 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-4340
Mailing Address - Country:US
Mailing Address - Phone:541-882-7401
Mailing Address - Fax:541-883-1102
Practice Address - Street 1:2340 S 6TH ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-4340
Practice Address - Country:US
Practice Address - Phone:541-882-7401
Practice Address - Fax:541-883-1102
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-2087111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR00WCHPWBMedicare PIN