Provider Demographics
NPI:1215127360
Name:STONE, KEITH MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:MICHAEL
Last Name:STONE
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 1:1432 N 7TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2524
Mailing Address - Country:US
Mailing Address - Phone:602-222-9595
Mailing Address - Fax:602-234-1211
Practice Address - Street 1:1432 N 7TH ST STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2524
Practice Address - Country:US
Practice Address - Phone:602-222-9595
Practice Address - Fax:602-234-1211
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3458111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZDC3458Medicare PIN
AZT42191Medicare UPIN