Provider Demographics
NPI:1003326075
Name:KEIM FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:KEIM FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:KEIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-444-3234
Mailing Address - Street 1:804 W HIGHWAY 50 STE 210
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1827
Mailing Address - Country:US
Mailing Address - Phone:618-607-0110
Mailing Address - Fax:618-607-0550
Practice Address - Street 1:804 W HIGHWAY 50 STE 210
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1827
Practice Address - Country:US
Practice Address - Phone:618-444-3234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012191111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty