Provider Demographics
NPI:1083788772
Name:KEIM, DOUGLAS JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:JOHN
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 1:339 OLD HAYMAKER RD
Mailing Address - Street 2:SUITE 1900
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-1435
Mailing Address - Country:US
Mailing Address - Phone:412-372-7500
Mailing Address - Fax:412-372-7531
Practice Address - Street 1:339 OLD HAYMAKER RD
Practice Address - Street 2:SUITE 1900
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-1435
Practice Address - Country:US
Practice Address - Phone:412-372-7500
Practice Address - Fax:412-372-7531
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-006382-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU59292Medicare UPIN