Provider Demographics
NPI:1245447747
Name:LYNCH, KEITH PATRICK (DC)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:PATRICK
Last Name:LYNCH
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 1:136 BUFFALO RUN RD
Mailing Address - Street 2:
Mailing Address - City:STANARDSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22973-3659
Mailing Address - Country:US
Mailing Address - Phone:434-985-6094
Mailing Address - Fax:434-245-8456
Practice Address - Street 1:1410 INCARNATION DR STE 202C
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-5708
Practice Address - Country:US
Practice Address - Phone:434-245-8456
Practice Address - Fax:434-245-8457
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104 001987111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA180813OtherANTHEM BLUE CROSS AND BLU
VAU74174Medicare UPIN