Provider Demographics
NPI:1194897991
Name:KEYS, ANNA GURULEVA (DC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:GURULEVA
Last Name:KEYS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 W MISSION AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92128
Mailing Address - Country:US
Mailing Address - Phone:760-839-3448
Mailing Address - Fax:760-839-3405
Practice Address - Street 1:240 W MISSION AVE
Practice Address - Street 2:SUITE C
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92128
Practice Address - Country:US
Practice Address - Phone:760-839-3448
Practice Address - Fax:760-839-3405
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27244111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC27244Medicare ID - Type Unspecified