Provider Demographics
NPI:1669560520
Name:KEITER, TRICIA (DC)
Entity type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:
Last Name:KEITER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5432 SPRING HILL DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-4559
Mailing Address - Country:US
Mailing Address - Phone:352-684-7676
Mailing Address - Fax:352-684-6262
Practice Address - Street 1:5432 SPRING HILL DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-4559
Practice Address - Country:US
Practice Address - Phone:352-684-7676
Practice Address - Fax:352-684-6262
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8145111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
E58524Medicare ID - Type Unspecified
U86006Medicare UPIN