Individual provider Active NPI

Bryon Carl Keil, DC

  • Chiropractor
  • Fargo, ND
National Provider Identifier
1063536704
Registry record updated Dec 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
703 Issued in ND
Practice address
3369 39TH St S Ste 3
Fargo, ND 58104-7542
Phone
(701) 367-6980
NPI assigned
Mar 19, 2007
Last updated
Dec 21, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 703 ND Primary

Addresses

Primary practice location

3369 39TH St S Ste 3
Fargo, ND 58104-7542

Mailing address

3369 39TH St. S Suite. 3
Fargo, ND 58104-6985
Phone (701) 367-6980

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
703NDMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Full Life Chiropractic PLLC PastSince Apr 21, 2010 Accepting new patients
United Health Chiropractic and Wellness Chiropractor Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324425600000",
    "number": "1063536704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3369 39TH ST. S SUITE. 3",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581046985",
            "telephone_number": "701-367-6980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3369 39TH ST S STE 3",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581047542",
            "telephone_number": "701-367-6980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEIL",
        "first_name": "BRYON",
        "middle_name": "CARL",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-19",
        "last_updated": "2011-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "ND",
            "license": "703",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.