MEDICARE: KEITH CLINIC OF CHIROPRACTIC OF MONROE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598741738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEITH CLINIC OF CHIROPRACTIC OF MONROE

Provider Business Mailing Address
First Line	:	2606 W ROOSEVELT BLVD STE A
Second Line	:
City	:	MONROE
State	:	NC
Zip	:	28110-8327
Country	:	US
Telephone Number	:	704-291-9000
Fax Number	:	704-291-9102

Provider Business Practice Location Address
First Line	:	2606 W ROOSEVELT BLVD STE A
Second Line	:
City	:	MONROE
State	:	NC
Zip	:	28110-8327
Country	:	US
Telephone Number	:	704-291-9000
Fax Number	:	704-291-9102

Authorized Official
Title or Position	:	OWNER
Name	:	DR. FERRELL K PITTMAN
Credential	:	DC
Telephone Number	:	704-291-9000

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	04/29/2011

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