Provider Demographics
NPI:1801065479
Name:UNGAR, KEITH S (DC)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:S
Last Name:UNGAR
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 1:2828 S ARLINGTON RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-4726
Mailing Address - Country:US
Mailing Address - Phone:330-896-8500
Mailing Address - Fax:330-896-8383
Practice Address - Street 1:2828 S ARLINGTON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-4726
Practice Address - Country:US
Practice Address - Phone:330-896-8500
Practice Address - Fax:330-896-8383
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1083111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2224435OtherMEDICAID
OH0602468Medicaid
OH000000186974OtherANTHEM
OH000000186974OtherANTHEM
OH2224435OtherMEDICAID