Provider Demographics
NPI:1073657417
Name:KEYES, KEVIN C (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:C
Last Name:KEYES
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 1:150 RIVER RD STE C1
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-8917
Mailing Address - Country:US
Mailing Address - Phone:973-316-8888
Mailing Address - Fax:973-316-0984
Practice Address - Street 1:150 RIVER RD STE C1
Practice Address - Street 2:
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-8917
Practice Address - Country:US
Practice Address - Phone:973-316-8888
Practice Address - Fax:973-316-0984
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00337100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ38MC00337100OtherSTATE LICENSE