Provider Demographics
NPI:1669236741
Name:KEETH, JOHN STUART (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:STUART
Last Name:KEETH
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 1:630 E WOOLBRIGHT RD APT 309
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-6198
Mailing Address - Country:US
Mailing Address - Phone:405-315-8636
Mailing Address - Fax:
Practice Address - Street 1:3200 S CONGRESS AVE STE 102
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-9041
Practice Address - Country:US
Practice Address - Phone:561-877-5525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14552111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor