Provider Demographics
NPI:1205108834
Name:PROCTOR KEENE CLINIC
Entity type:Organization
Organization Name:PROCTOR KEENE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:KEENE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-291-1971
Mailing Address - Street 1:1101 MARTHA BERRY BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1611
Mailing Address - Country:US
Mailing Address - Phone:706-291-1971
Mailing Address - Fax:706-291-1972
Practice Address - Street 1:1101 MARTHA BERRY BLVD NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1611
Practice Address - Country:US
Practice Address - Phone:706-291-1971
Practice Address - Fax:706-291-1972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA679111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty