Organization Active NPI

Keys Chiropractic, P. C.

  • Chiropractor
  • Fort Wayne, IN
National Provider Identifier
1205027877
Registry record updated Aug 7, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
08001845A Issued in IN
Legal business name
KEYS CHIROPRACTIC, P. C.
Practice address
2422 Lake Ave
Park Lake Medical BLDG
Fort Wayne, IN 46805-5406
Phone
(260) 420-8803
Fax
(260) 420-6814
NPI assigned
Aug 7, 2007
Last updated
Aug 7, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2007

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

Authorized official

Name
Dr. Kimberly A Keys, D.C.
Title
President
Phone
(260) 420-8803

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 08001845A IN Primary

Addresses

Primary practice location

2422 Lake Ave
Park Lake Medical BLDG
Fort Wayne, IN 46805-5406

Mailing address

2422 Lake Ave
Park Lake Medical BLDG
Fort Wayne, IN 46805-5406
Phone (260) 420-8803

Other identifiers 2

IdentifierTypeStateIssuer
152800OtherINMEDICARE
0000190008OtherINBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031217000737 IN Part B Supplier - Clinic/Group Practice 5092612077 Receives reassigned benefits from 1 practitioner
Practice locations: Fort Wayne, IN

National Provider Directory

National Provider Directory

Locations

2422 Lake Ave
Fort Wayne, IN 46805
Phone (260) 255-6376

9536 Lima Rd
Fort Wayne, IN 46818
Phone (219) 420-8803

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1186444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186444800000",
    "number": "1205027877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2422 LAKE AVE",
            "address_2": "PARK LAKE MEDICAL BLDG",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468055406",
            "telephone_number": "260-420-8803",
            "fax_number": "260-420-6814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2422 LAKE AVE",
            "address_2": "PARK LAKE MEDICAL BLDG",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468055406",
            "telephone_number": "260-420-8803",
            "fax_number": "260-420-6814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEYS CHIROPRACTIC, P. C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-07",
        "last_updated": "2007-08-07",
        "status": "A",
        "authorized_official_last_name": "KEYS",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "260-420-8803",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IN",
            "license": "08001845A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "152800",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0000190008",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.