Provider Demographics
NPI:1083712269
Name:KEAN, BRIAN M (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:M
Last Name:KEAN
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 1:504 RED BANKS RD # C
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5725
Mailing Address - Country:US
Mailing Address - Phone:252-321-3579
Mailing Address - Fax:
Practice Address - Street 1:504 RED BANKS RD # C
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5725
Practice Address - Country:US
Practice Address - Phone:252-321-3579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2609111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC017AWOtherBC/BS PROVIDER ID NUMBER
NC890835LMedicaid
NCU74857Medicare UPIN
NC890835LMedicaid