Provider Demographics
NPI:1396417507
Name:BARE CHIROPRACTIC
Entity Type:Organization
Organization Name:BARE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:KEOGH
Authorized Official - Suffix:IV
Authorized Official - Credentials:DC
Authorized Official - Phone:419-215-4326
Mailing Address - Street 1:3839 GRAND AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-7650
Mailing Address - Country:US
Mailing Address - Phone:419-215-4326
Mailing Address - Fax:
Practice Address - Street 1:3839 GRAND AVE STE 5
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-7650
Practice Address - Country:US
Practice Address - Phone:419-215-4326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty