Healthcare Provider Details

I. General information

NPI: 1922033216
Provider Name (Legal Business Name): COURTLAND D KEITH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 MEANY AVE STE B
BAKERSFIELD CA
93308
US

IV. Provider business mailing address

7800 MEANY AVE STE B
BAKERSFIELD CA
93308-5014
US

V. Phone/Fax

Practice location:
  • Phone: 661-679-7902
  • Fax: 661-829-0608
Mailing address:
  • Phone: 661-679-7902
  • Fax: 661-397-6644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number25723
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: