Provider Demographics
NPI:1114126182
Name:KEEHN CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:KEEHN CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:KEEHN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-659-8411
Mailing Address - Street 1:1241 STATE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-3612
Mailing Address - Country:US
Mailing Address - Phone:360-659-8411
Mailing Address - Fax:360-658-1033
Practice Address - Street 1:1241 STATE AVE STE 101
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-3612
Practice Address - Country:US
Practice Address - Phone:360-659-8411
Practice Address - Fax:360-658-1033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA600424793111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0201599OtherDEPARTMENT OF LABOR AND I