Healthcare Provider Details

I. General information

NPI: 1851498984
Provider Name (Legal Business Name): KEITH MARTIN BARTLEY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 MAIN ST
JASPER IN
47546-2835
US

IV. Provider business mailing address

1201 MAIN ST
JASPER IN
47546-2835
US

V. Phone/Fax

Practice location:
  • Phone: 812-482-6600
  • Fax: 812-482-6615
Mailing address:
  • Phone: 812-482-6600
  • Fax: 812-482-6615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08001246
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: