Provider Demographics
NPI:1154515575
Name:LITWAK, KEITH (DC)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:LITWAK
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 1:2941 NW 28TH TER
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-6006
Mailing Address - Country:US
Mailing Address - Phone:561-272-7000
Mailing Address - Fax:561-883-1508
Practice Address - Street 1:2941 NW 28TH TER
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-6006
Practice Address - Country:US
Practice Address - Phone:561-272-7000
Practice Address - Fax:561-883-1508
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5747111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22199Medicare UPIN