Provider Demographics
NPI:1962100495
Name:KEYSTONE CHIROPRACTIC & WELLNESS, PLLC
Entity type:Organization
Organization Name:KEYSTONE CHIROPRACTIC & WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-701-8587
Mailing Address - Street 1:7380 S SHELBY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-5663
Mailing Address - Country:US
Mailing Address - Phone:949-701-8587
Mailing Address - Fax:
Practice Address - Street 1:613 E FORT UNION BLVD
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-5531
Practice Address - Country:US
Practice Address - Phone:801-562-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty