MEDICARE: DR. KEITH MANNING BRASSFIELD D.C.

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	111NR0400X	Rehabilitation Chiropractor	0104557272	VA
2	111N00000X	Chiropractor	0104557272	VA

General Provider Information

NPI Number	:	1467807867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEITH MANNING BRASSFIELD D.C.

Provider Business Mailing Address
First Line	:	552 FORT EVANS RD STE 306
Second Line	:
City	:	LEESBURG
State	:	VA
Zip	:	20176-3378
Country	:	US
Telephone Number	:	703-771-3204
Fax Number	:	703-771-3273

Provider Business Practice Location Address
First Line	:	552 FORT EVANS RD STE 306
Second Line	:
City	:	LEESBURG
State	:	VA
Zip	:	20176-3378
Country	:	US
Telephone Number	:	703-771-3204
Fax Number	:	703-771-3204

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

Provider Enumeration Date	:	05/04/2016
Last Update Date	:	02/17/2021

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