Provider Demographics
NPI:1831177153
Name:MADDEN, KEITH (DC)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:MADDEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 WILLIAMS ST
Mailing Address - Street 2:STE B
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-7408
Mailing Address - Country:US
Mailing Address - Phone:413-442-0913
Mailing Address - Fax:413-442-1872
Practice Address - Street 1:5 CHESHIRE RD
Practice Address - Street 2:STE 139
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-1832
Practice Address - Country:US
Practice Address - Phone:413-442-0913
Practice Address - Fax:413-442-1872
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1374111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1610317Medicaid
MAMAY35926Medicare ID - Type Unspecified