Provider Demographics
NPI:1699870014
Name:ELDRIDGE-KEELIN, ALICIA (DC)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:ELDRIDGE-KEELIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 WOLOHAN DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41102-8940
Mailing Address - Country:US
Mailing Address - Phone:606-928-3364
Mailing Address - Fax:606-928-1531
Practice Address - Street 1:1320 WOLOHAN DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102-8940
Practice Address - Country:US
Practice Address - Phone:606-928-3364
Practice Address - Fax:606-928-1531
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4794111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85003077Medicaid
V00480Medicare UPIN
KY6104401Medicare PIN