Provider Demographics
NPI:1346746831
Name:KEENE, GRETCHEN KAYE (DC)
Entity Type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:KAYE
Last Name:KEENE
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 1:4717 CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3221
Mailing Address - Country:US
Mailing Address - Phone:651-762-8040
Mailing Address - Fax:
Practice Address - Street 1:4717 CLARK AVE
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3221
Practice Address - Country:US
Practice Address - Phone:651-762-8040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6476111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor