Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | IL |
NPI | 1255495818 |
---|---|
Provider Name | Dr. Jack D. Keyser |
First Address | Palatine, IL 60067-7258 |
Second Address | Palatine, IL 60067-8207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2006 |
Last Update Date | 08/07/2007 |