Keith L Bostaph, DC
Individual provider Active NPI Chiropractor · Lady Lake, FL
NPI 1962416149 · NPPES record last updated Oct 10, 2013
Key facts
- NPI
- 1962416149
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- CH8400 (FL)
- Practice address
- 6053 Spinnaker Loop
Lady Lake, FL 32159-5922 - Phone
- (352) 638-9090
- Fax
- (352) 638-9092
- NPI assigned
- Jul 27, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Highland Health & Wellness Center LLC | Chiropractor | Past |
Accepting new patients |
| McKenney Chiropractic Center PA | Chiropractor | Past |
Accepting new patients |
| Highland Chiropractic Inc | Chiropractor | Past |
Accepting new patients |
| McKenney Chiropractic Center PA | Chiropractor | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | CH8400 | FL | Yes |
Addresses
Primary practice location
6053 Spinnaker Loop
Lady Lake, FL 32159-5922
Mailing address
6053 Spinnaker Loop
Lady Lake, FL 32159-5922
Phone (352) 638-9090
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004450700 | Medicaid | FL | |
| 70100 | Other | FL | BCBS |
Other providers in Lady Lake, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 10, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.