Provider Demographics
NPI:1366650731
Name:KEOSHIAN, CRAIG CAREY (DC)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:CAREY
Last Name:KEOSHIAN
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 1:24510 TOWN CENTER DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1337
Mailing Address - Country:US
Mailing Address - Phone:661-263-7667
Mailing Address - Fax:661-288-1129
Practice Address - Street 1:24510 TOWN CENTER DR
Practice Address - Street 2:SUITE 230
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-1337
Practice Address - Country:US
Practice Address - Phone:661-263-7667
Practice Address - Fax:661-288-1129
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17303111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC17303Medicare ID - Type Unspecified