Individual
KEITH ALLEN VANSOELEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
55TH AND GRANT STREETS, HINSDALE, IL 60521
(630) 570-8240
Mailing address
577 GRAND PARKE DR, JACKSONVILLE, FL 32259-5258
(904) 287-8179
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AL 1258
FL
Other
Enumeration date
11/25/2008
Last updated
10/14/2011
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