Provider Demographics
NPI:1093893489
Name:BAGBY, KEANE JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:KEANE
Middle Name:JOSEPH
Last Name:BAGBY
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 1:435 SW 41ST ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-4926
Mailing Address - Country:US
Mailing Address - Phone:425-251-9770
Mailing Address - Fax:425-251-9846
Practice Address - Street 1:435 SW 41ST ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-4926
Practice Address - Country:US
Practice Address - Phone:425-251-9770
Practice Address - Fax:425-251-9846
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH000001865111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WABA3849OtherREGENCE
WA24854OtherLABOR & INDUSTRIES
WA24854OtherLABOR & INDUSTRIES
WABA3849OtherREGENCE