Provider Demographics
NPI:1437482056
Name:MONDSCHEIN, KEITH D (DC)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:D
Last Name:MONDSCHEIN
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 1:2577 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-9411
Mailing Address - Country:US
Mailing Address - Phone:716-833-1926
Mailing Address - Fax:716-832-0124
Practice Address - Street 1:2577 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-9411
Practice Address - Country:US
Practice Address - Phone:716-833-1926
Practice Address - Fax:716-832-0124
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011746111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400016843Medicare UPIN