Provider Demographics
NPI:1770724932
Name:ADLER, KEITH DOUGLAS (LAC)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:DOUGLAS
Last Name:ADLER
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 CHAPALA ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-3075
Mailing Address - Country:US
Mailing Address - Phone:805-680-4513
Mailing Address - Fax:
Practice Address - Street 1:1500 CHAPALA ST
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-3075
Practice Address - Country:US
Practice Address - Phone:805-680-4513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9577171100000X
HI734171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist