Provider Demographics
NPI:1396858734
Name:KEEHN, ANDREW L (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:L
Last Name:KEEHN
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 1:314 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-6160
Mailing Address - Country:US
Mailing Address - Phone:781-396-1070
Mailing Address - Fax:781-396-6607
Practice Address - Street 1:314 MAIN ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-6160
Practice Address - Country:US
Practice Address - Phone:781-396-1070
Practice Address - Fax:781-396-6607
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1124111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA351214OtherHARVARD/PILGRAM NUMBER
MA721115OtherTUFTS NUMBER
MA5360963OtherAETNA NUMBER
MAY35829Medicare ID - Type UnspecifiedMEDICARE AND BCBS NUMBER