Provider Demographics
NPI:1720100209
Name:BILLSTEIN, KEITH MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:MICHAEL
Last Name:BILLSTEIN
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 1:3722 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-1465
Mailing Address - Country:US
Mailing Address - Phone:763-427-7122
Mailing Address - Fax:
Practice Address - Street 1:3722 7TH AVE
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-1465
Practice Address - Country:US
Practice Address - Phone:763-427-7122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1983111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3710867Medicaid
MN0G117BIOtherINDIVIDUAL BLUE CROSS
MN625327000OtherMN MEDICAL ASS.INDIVUAL
MN0G117BIOtherINDIVIDUAL BLUE CROSS