Provider Demographics
NPI:1740282045
Name:KENITZER, KEITH W (DC)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:W
Last Name:KENITZER
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 1:700 GAGEL AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-4008
Mailing Address - Country:US
Mailing Address - Phone:502-366-7386
Mailing Address - Fax:502-366-2222
Practice Address - Street 1:700 GAGEL AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-4008
Practice Address - Country:US
Practice Address - Phone:502-366-7386
Practice Address - Fax:502-366-2222
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3816111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1136138OtherPASSPORT
KY85002103Medicaid
KY000000221631OtherANTHEM
KY611274059A12OtherANTHEM SENIOR
KY350036040OtherUNITED RAILROAD MEDICARE
KY350036040OtherUNITED RAILROAD MEDICARE
KY611274059A12OtherANTHEM SENIOR