Provider Demographics
NPI:1386610616
Name:KEITH, ALEX DAVID (DC CCSP)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:DAVID
Last Name:KEITH
Suffix:
Gender:M
Credentials:DC CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460
Mailing Address - Country:US
Mailing Address - Phone:561-582-2225
Mailing Address - Fax:561-582-6358
Practice Address - Street 1:1814 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460
Practice Address - Country:US
Practice Address - Phone:561-582-2225
Practice Address - Fax:561-582-6358
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6682111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1386610616OtherNPI
FL1043231129OtherNPI
FL1043231129OtherNPI
FL22995Medicare PIN