Provider Demographics
NPI:1396731907
Name:KEATES, AMANDA R (DC)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:R
Last Name:KEATES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:620 NC HIGHWAY 42 W
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-5803
Mailing Address - Country:US
Mailing Address - Phone:919-400-7909
Mailing Address - Fax:919-243-0530
Practice Address - Street 1:620 NC HIGHWAY 42 W
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-5803
Practice Address - Country:US
Practice Address - Phone:919-400-7909
Practice Address - Fax:919-243-0530
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3960111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC089979Medicare PIN
NCV04633Medicare UPIN