Provider Demographics
NPI:1053437111
Name:KHALIL, KEITH JUDE (DC)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:JUDE
Last Name:KHALIL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22790 KELLY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-2019
Mailing Address - Country:US
Mailing Address - Phone:586-771-7766
Mailing Address - Fax:586-771-9374
Practice Address - Street 1:22790 KELLY RD
Practice Address - Street 2:SUITE C
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-2019
Practice Address - Country:US
Practice Address - Phone:586-771-7766
Practice Address - Fax:586-771-9374
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKK005605111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M03510Medicare ID - Type Unspecified