Provider Demographics
NPI:1528147022
Name:BERNING, KEITH B (DC)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:B
Last Name:BERNING
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 1:3920 US HIGHWAY 93 N
Mailing Address - Street 2:STE D
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MT
Mailing Address - Zip Code:59870-6478
Mailing Address - Country:US
Mailing Address - Phone:406-777-7172
Mailing Address - Fax:406-777-7266
Practice Address - Street 1:3920 US HIGHWAY 93 N
Practice Address - Street 2:STE D
Practice Address - City:STEVENSVILLE
Practice Address - State:MT
Practice Address - Zip Code:59870-6478
Practice Address - Country:US
Practice Address - Phone:406-777-7172
Practice Address - Fax:406-777-7266
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTCHI-CHI-LIC-3472111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806837600Medicaid