Provider Demographics
NPI:1124359484
Name:O'KEEFE, DIANE ROSE (DC)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:ROSE
Last Name:O'KEEFE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 SAN CARLOS AVE
Mailing Address - Street 2:
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-4643
Mailing Address - Country:US
Mailing Address - Phone:650-307-4419
Mailing Address - Fax:650-726-8192
Practice Address - Street 1:1317 18TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-2822
Practice Address - Country:US
Practice Address - Phone:650-307-4419
Practice Address - Fax:650-726-8192
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18570111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor