=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114241312
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH ANNE KEETER DC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2010
-----------------------------------------------------
Last Update Date | 10/11/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1450 ROANOKE RD
-----------------------------------------------------
City | DALEVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24083-2935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-966-0920
-----------------------------------------------------
Fax | 844-777-1745
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1450 ROANOKE RD
-----------------------------------------------------
City | DALEVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24083-2935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-841-1495
-----------------------------------------------------
Fax | 540-966-0921
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 43
-----------------------------------------------------
License Number State | AK
-----------------------------------------------------