Provider Demographics
NPI:1376163683
Name:BERNARD KEENUM, LLC
Entity Type:Organization
Organization Name:BERNARD KEENUM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KEENUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:228-337-0440
Mailing Address - Street 1:11505 CINEMA DR STE 7
Mailing Address - Street 2:
Mailing Address - City:DIBERVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39540-9703
Mailing Address - Country:US
Mailing Address - Phone:228-365-0449
Mailing Address - Fax:228-365-2314
Practice Address - Street 1:11505 CINEMA DR STE 7
Practice Address - Street 2:
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-9703
Practice Address - Country:US
Practice Address - Phone:228-365-0449
Practice Address - Fax:228-365-2314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty