Provider Demographics
NPI:1205844222
Name:KEHOE, MARK ALLEN (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:KEHOE
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 1:908 LIBERTY STREET
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323
Mailing Address - Country:US
Mailing Address - Phone:814-432-5423
Mailing Address - Fax:814-437-2751
Practice Address - Street 1:908 LIBERTY STREET
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323
Practice Address - Country:US
Practice Address - Phone:814-432-5423
Practice Address - Fax:814-437-2751
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002789L111N00000X
GACHIR002307111N00000X
FLCH4765111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA131908OtherHIGHMARK
PA0010600300001Medicaid
T29423Medicare UPIN
PA0010600300001Medicaid