Provider Demographics
NPI:1952584369
Name:KEITHLEY, ALAN DALE (DC)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:DALE
Last Name:KEITHLEY
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 1:715 KENSINGTON STE 24A
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-5700
Mailing Address - Country:US
Mailing Address - Phone:406-541-9150
Mailing Address - Fax:406-830-3857
Practice Address - Street 1:715 KENSINGTON STE 24A
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-5700
Practice Address - Country:US
Practice Address - Phone:406-541-9150
Practice Address - Fax:406-830-3857
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1043111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTU94196OtherUPIN