Provider Demographics
NPI:1962676478
Name:GUTZMANN, KEITH PATRICK (DC)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:PATRICK
Last Name:GUTZMANN
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 1:16201 96TH ST
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-4029
Mailing Address - Country:US
Mailing Address - Phone:718-848-4200
Mailing Address - Fax:718-848-4049
Practice Address - Street 1:16201 96TH ST
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-4029
Practice Address - Country:US
Practice Address - Phone:718-848-4200
Practice Address - Fax:718-848-4049
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007016-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor