Provider Demographics
NPI:1124230214
Name:OKERSTROM, KEITH JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:JAMES
Last Name:OKERSTROM
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 1:2005 NW GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-4366
Mailing Address - Country:US
Mailing Address - Phone:503-449-4945
Mailing Address - Fax:541-738-0704
Practice Address - Street 1:2005 NW GRANT AVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-4366
Practice Address - Country:US
Practice Address - Phone:541-758-9393
Practice Address - Fax:541-738-0704
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3661111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor