Provider Demographics
NPI:1396755591
Name:LINEBERRY, KEITH HARDEN I (DC)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:HARDEN
Last Name:LINEBERRY
Suffix:I
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:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:MAYODAN
Mailing Address - State:NC
Mailing Address - Zip Code:27027-0010
Mailing Address - Country:US
Mailing Address - Phone:336-548-2225
Mailing Address - Fax:336-548-3059
Practice Address - Street 1:901 S AYERSVILLE RD
Practice Address - Street 2:
Practice Address - City:MAYODAN
Practice Address - State:NC
Practice Address - Zip Code:27027-0010
Practice Address - Country:US
Practice Address - Phone:336-548-2225
Practice Address - Fax:336-548-3059
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC2360111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0826UOtherBLUE CROSS BLUE SHIELD
NC8908264Medicaid
NC0826UOtherBLUE CROSS BLUE SHIELD
U67259Medicare UPIN