Provider Demographics
NPI:1902116718
Name:KEENAN CHIROPRACTIC PA
Entity Type:Organization
Organization Name:KEENAN CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KEENAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-949-0220
Mailing Address - Street 1:3388 WOODS EDGE CIRCLE SUITE 102
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134
Mailing Address - Country:US
Mailing Address - Phone:239-949-0220
Mailing Address - Fax:239-949-0244
Practice Address - Street 1:3388 WOODS EDGE CIRCLE SUITE 102
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134
Practice Address - Country:US
Practice Address - Phone:239-949-0220
Practice Address - Fax:239-949-0244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8224111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70005Medicare PIN
U86011Medicare UPIN