Healthcare Provider Details

I. General information

NPI: 1265442834
Provider Name (Legal Business Name): KEITH SCOTT OVERLAND D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 EAST AVE STE 313
NORWALK CT
06851-4902
US

IV. Provider business mailing address

83 EAST AVE STE 313
NORWALK CT
06851-4902
US

V. Phone/Fax

Practice location:
  • Phone: 203-838-9795
  • Fax: 203-853-2078
Mailing address:
  • Phone: 203-838-9795
  • Fax: 203-853-2078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number333
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: