Provider Demographics
NPI:1518043074
Name:STEVENS, KEITH A (DC)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:A
Last Name:STEVENS
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 1:4222 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-5048
Mailing Address - Country:US
Mailing Address - Phone:678-595-3475
Mailing Address - Fax:770-429-8185
Practice Address - Street 1:543 ROBERTS CT NW
Practice Address - Street 2:SUITE B
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-4830
Practice Address - Country:US
Practice Address - Phone:770-429-1515
Practice Address - Fax:770-429-8185
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007707111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor