Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 0104556147 | VA |
NPI | 1316957855 |
---|---|
Provider Name | Jacquie Christine Keats |
First Address | Blacksburg, VA 24060-6601 |
Second Address | Blacksburg, VA 24060-6601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 22/09/2020 |