Provider Demographics
NPI:1053909564
Name:KEYSER, IAN WYATT (DC)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:WYATT
Last Name:KEYSER
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 1:25 SURREY LN
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-2257
Mailing Address - Country:US
Mailing Address - Phone:203-450-3804
Mailing Address - Fax:
Practice Address - Street 1:970 SUMMER ST FL 1
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5542
Practice Address - Country:US
Practice Address - Phone:203-276-1293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-10
Last Update Date:2021-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002205111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty