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General NPI Number Information
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NPI Number | 1114029303
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Entity Type | Individual
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Provider Name | KEITH A MINIACI DC
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Gender | Male
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 10/04/2021
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Provider Practice Location Address
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Address Line | 53 HIGH ST
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City | EAST HAVEN
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State | CT
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Zip | 06512-2315
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Country | US
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Telephone | 203-469-5210
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Fax | 203-468-8598
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Provider Business Mailing Address
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Address Line | 111 SUNRISE HILL CIR
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City | ORANGE
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State | CT
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Zip | 06477-1132
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Country | US
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Telephone | 203-469-5210
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Fax | 203-468-8598
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 000410
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License Number State | CT
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