1033188362 NPI number — DR. BRANDIE ELIZABETH KEATES DC

Table of content: DR. BRANDIE ELIZABETH KEATES DC (NPI 1033188362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033188362 NPI number — DR. BRANDIE ELIZABETH KEATES DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEATES
Provider First Name:
BRANDIE
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033188362
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
992 OLD EAGLE SCHOOL RD
Provider Second Line Business Mailing Address:
SUITE 902
Provider Business Mailing Address City Name:
WAYNE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19087-1803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-337-7463
Provider Business Mailing Address Fax Number:
610-337-9505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
992 OLD EAGLE SCHOOL RD
Provider Second Line Business Practice Location Address:
SUITE 902
Provider Business Practice Location Address City Name:
WAYNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19087-1803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-337-7463
Provider Business Practice Location Address Fax Number:
610-337-9505
Provider Enumeration Date:
03/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC008904 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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