Provider Demographics
NPI:1003176231
Name:KEIM, NICHOLAS D (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:D
Last Name:KEIM
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 1:1207 THOUVENOT LN STE 100
Mailing Address - Street 2:
Mailing Address - City:SHILOH
Mailing Address - State:IL
Mailing Address - Zip Code:62269-8917
Mailing Address - Country:US
Mailing Address - Phone:618-234-8300
Mailing Address - Fax:618-234-8295
Practice Address - Street 1:1207 THOUVENOT LN STE 100
Practice Address - Street 2:
Practice Address - City:SHILOH
Practice Address - State:IL
Practice Address - Zip Code:62269-8917
Practice Address - Country:US
Practice Address - Phone:618-234-8300
Practice Address - Fax:618-234-8295
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012191111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor