MEDICARE: KEYSTONE CHIROPRACTIC INC

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	CH9215	FL

General Provider Information

NPI Number	:	1720228539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEYSTONE CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	330A S LAWRENCE BLVD
Second Line	:
City	:	KEYSTONE HEIGHTS
State	:	FL
Zip	:	32656-9219
Country	:	US
Telephone Number	:	352-473-9777
Fax Number	:	352-473-9777

Provider Business Practice Location Address
First Line	:	330A S LAWRENCE BLVD
Second Line	:
City	:	KEYSTONE HEIGHTS
State	:	FL
Zip	:	32656-9219
Country	:	US
Telephone Number	:	352-473-9777
Fax Number	:	352-473-9777

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	DR. JINNIFER MELISSA STEPHAN
Credential	:	D.C.
Telephone Number	:	352-473-9777

Provider Enumeration Date	:	03/06/2009
Last Update Date	:	03/06/2009

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Directions to “KEYSTONE CHIROPRACTIC INC ” Practice Location

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