Provider Demographics
NPI:1174018683
Name:KEYS, BRADLEY R (DC)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:R
Last Name:KEYS
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:PARAGON MEDICAL BUILDING
Mailing Address - Street 2:9149 ESTATE THOMAS, STE. 203
Mailing Address - City:ST. THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802
Mailing Address - Country:US
Mailing Address - Phone:340-690-4994
Mailing Address - Fax:
Practice Address - Street 1:PARAGON MEDICAL BUILDING
Practice Address - Street 2:9149 ESTATE THOMAS, STE. 203
Practice Address - City:ST. THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802
Practice Address - Country:US
Practice Address - Phone:340-690-4994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI85111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI85OtherSTATE LICENSE