Provider Demographics
NPI:1346589264
Name:701 CHIROPRACTIC PC
Entity Type:Organization
Organization Name:701 CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:D
Authorized Official - Last Name:KEOGH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-858-0014
Mailing Address - Street 1:201 UNIVERSITY AVE W
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-2349
Mailing Address - Country:US
Mailing Address - Phone:701-858-0014
Mailing Address - Fax:
Practice Address - Street 1:201 UNIVERSITY AVE W
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-2349
Practice Address - Country:US
Practice Address - Phone:701-858-0014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND893111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty