Healthcare Provider Details

I. General information

NPI: 1083587000
Provider Name (Legal Business Name): KEITH CLINIC ESTRAMONTE CHIROPRACTIC KINGS MOUNTAIN PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510A W KING ST
KINGS MOUNTAIN NC
28086-3310
US

IV. Provider business mailing address

510A W KING ST STE A
KINGS MOUNTAIN NC
28086-3310
US

V. Phone/Fax

Practice location:
  • Phone: 980-396-2811
  • Fax:
Mailing address:
  • Phone: 980-396-2811
  • Fax: 980-221-1654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DEBRA LEE HUDSON
Title or Position: SENIOR ACCOUNTING ANALYST
Credential:
Phone: 704-420-4690