Provider Demographics
NPI:1902803018
Name:SCHERTELL, KEITH ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ALLEN
Last Name:SCHERTELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 BLANDING BLVD
Mailing Address - Street 2:STE 106
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-7724
Mailing Address - Country:US
Mailing Address - Phone:904-272-4555
Mailing Address - Fax:904-276-2521
Practice Address - Street 1:868 BLANDING BLVD
Practice Address - Street 2:STE 128
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065
Practice Address - Country:US
Practice Address - Phone:904-272-4555
Practice Address - Fax:904-276-2521
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0007619111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381197200Medicare ID - Type Unspecified
FLU80941Medicare UPIN
FLE4313ZMedicare ID - Type Unspecified