MEDICARE: DR. KEITH A MINIACI DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	000410	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	050000410CT05	OTHER		ANTHEM BCS

General Provider Information

NPI Number	:	1114029303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEITH A MINIACI DC

Provider Business Mailing Address
First Line	:	111 SUNRISE HILL CIR
Second Line	:
City	:	ORANGE
State	:	CT
Zip	:	06477-1132
Country	:	US
Telephone Number	:	203-469-5210
Fax Number	:	203-468-8598

Provider Business Practice Location Address
First Line	:	53 HIGH ST
Second Line	:
City	:	EAST HAVEN
State	:	CT
Zip	:	06512-2315
Country	:	US
Telephone Number	:	203-469-5210
Fax Number	:	203-468-8598

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	02/12/2026

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