Provider Demographics
NPI:1750712360
Name:CHATWIN, KEITH
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:
Last Name:CHATWIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8545 S REDWOOD RD
Mailing Address - Street 2:UNIT B1
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-5576
Mailing Address - Country:US
Mailing Address - Phone:801-255-2782
Mailing Address - Fax:801-255-2782
Practice Address - Street 1:8545 S REDWOOD RD
Practice Address - Street 2:UNIT B1
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-5576
Practice Address - Country:US
Practice Address - Phone:801-255-2782
Practice Address - Fax:801-255-2782
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2013-PCA-UT000605374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide