Conneaut Lake Chiropractic, PC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

DC007703L Issued in PA

Legal business name

CONNEAUT LAKE CHIROPRACTIC, PC

Practice address

13245 Conneaut Lake Rd
Conneaut Lake, PA 16316-6809

Phone

(814) 382-8840

Fax

(814) 382-8840

NPI assigned

Apr 11, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Brett Alan Keyser, D.C.NPI 1083795801

Title

President

Phone

(814) 382-8840

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brett Alan Keyser, D.C.

  • Chiropractor
  • Conneaut Lake, PA
  • NPI 1083795801
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1207872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207872000000",
    "number": "1396918215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13245 CONNEAUT LAKE RD",
            "city": "CONNEAUT LAKE",
            "state": "PA",
            "postal_code": "163166809",
            "telephone_number": "814-382-8840",
            "fax_number": "814-382-8840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13245 CONNEAUT LAKE RD",
            "city": "CONNEAUT LAKE",
            "state": "PA",
            "postal_code": "163166809",
            "telephone_number": "814-382-8840",
            "fax_number": "814-382-8840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNEAUT LAKE CHIROPRACTIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-11",
        "last_updated": "2008-04-11",
        "status": "A",
        "authorized_official_last_name": "KEYSER",
        "authorized_official_first_name": "BRETT",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "814-382-8840",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "PA",
            "license": "DC007703L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BCBS",
            "identifier": "340625",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0017865180003",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chrissy M Bosley, LCSW QCSW
• Nour Majid Bussard, LPC
• Casey James Chapman, DC
• Kimberly Marie Conley, LCSW
• Conneaut Lake Area Ambulance Service
• Conneaut Valley Health Center Inc. (Conneaut Lake Health Center)
• Mindy Curtiss, CERT HEALTH COACH
• Ryan Scott Evans, D.O.
• Carrie Elizabeth Flemming
• Paul Thomas Foulk, DMD

• Chiropractor in Conneaut Lake, PA
• Providers in Conneaut Lake, PA by specialty
• Chiropractor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2008; 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.