MEDICARE: KEYSTONE CHIROPRACTIC LLC

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	2253	AL

General Provider Information

NPI Number	:	1609172048
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEYSTONE CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	3322 MEMORIAL PKWY SW
Second Line	:	SUITE 617
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-5335
Country	:	US
Telephone Number	:	256-270-9993
Fax Number	:	256-270-9994

Provider Business Practice Location Address
First Line	:	3322 MEMORIAL PKWY SW
Second Line	:	SUITE 617
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-5335
Country	:	US
Telephone Number	:	256-270-9993
Fax Number	:	256-270-9994

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. LISA D. INGRUM
Credential	:	D.C.
Telephone Number	:	256-270-9993

Provider Enumeration Date	:	02/02/2011
Last Update Date	:	02/02/2011

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Directions to “KEYSTONE CHIROPRACTIC LLC ” Practice Location

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