Provider Demographics
NPI:1386772234
Name:KEYSTONE CHIROPRACTIC, LTD, PC.
Entity type:Organization
Organization Name:KEYSTONE CHIROPRACTIC, LTD, PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:EMERSON
Authorized Official - Last Name:STIGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-323-3698
Mailing Address - Street 1:1425 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-5402
Mailing Address - Country:US
Mailing Address - Phone:570-323-3698
Mailing Address - Fax:570-326-2579
Practice Address - Street 1:1425 E 3RD ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-5402
Practice Address - Country:US
Practice Address - Phone:570-323-3698
Practice Address - Fax:570-326-2579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001998L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA804519OtherFIRST PRIORITY
PA50010109OtherCAPITAL
PAST124597OtherBCBS
PA00124597Medicare ID - Type Unspecified