Provider Demographics
NPI:1437119336
Name:WEIN, KEITH LLOYD (DC)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:LLOYD
Last Name:WEIN
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 1:2328 REDWOOD PL
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47129-1280
Mailing Address - Country:US
Mailing Address - Phone:502-376-9562
Mailing Address - Fax:
Practice Address - Street 1:2030 IN-337, SUITE 2A
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-2057
Practice Address - Country:US
Practice Address - Phone:812-738-1935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000999A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300064741Medicaid
INU56457Medicare UPIN