MEDICARE: DR. KEITH ALAN AMODEO CHIROPRACTOR

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	0000002563	TN

General Provider Information

NPI Number	:	1215375662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEITH ALAN AMODEO CHIROPRACTOR

Provider Business Mailing Address
First Line	:	777 W POPLAR AVE STE 104
Second Line	:
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-6500
Country	:	US
Telephone Number	:	901-853-8270
Fax Number	:

Provider Business Practice Location Address
First Line	:	777 W POPLAR AVE STE 104
Second Line	:
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-6500
Country	:	US
Telephone Number	:	901-853-8270
Fax Number	:

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

Provider Enumeration Date	:	06/07/2013
Last Update Date	:	06/07/2013

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