Provider Demographics
NPI:1780736116
Name:KEEZER CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:KEEZER CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:HENRI
Authorized Official - Last Name:KEEZER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-265-0402
Mailing Address - Street 1:3701 COLBY AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4979
Mailing Address - Country:US
Mailing Address - Phone:425-259-3700
Mailing Address - Fax:425-259-4283
Practice Address - Street 1:3701 COLBY AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4979
Practice Address - Country:US
Practice Address - Phone:425-259-3700
Practice Address - Fax:425-259-4283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033819111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA132672OtherLABOR AND INDUSTRIES
WA5059126OtherAETNA
WA2931KEOtherREGENCE
WACH00033819Medicaid
WAGAB12919Medicare ID - Type Unspecified