Provider Demographics
NPI:1538276829
Name:KEYSTONE FAMILY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:KEYSTONE FAMILY CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMFORDE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-746-6840
Mailing Address - Street 1:1825 WASHINGTON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-8932
Mailing Address - Country:US
Mailing Address - Phone:724-746-6840
Mailing Address - Fax:724-746-6870
Practice Address - Street 1:1825 WASHINGTON RD
Practice Address - Street 2:SUITE B
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-8932
Practice Address - Country:US
Practice Address - Phone:724-746-6840
Practice Address - Fax:724-746-6870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009413111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA=========OtherCOMMERCIAL
PA100600Medicare ID - Type UnspecifiedMEDICARE