Provider Demographics
NPI:1497842348
Name:KEYES, KEVIN JOHN (DC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:JOHN
Last Name:KEYES
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 1:17450 ST LUKES WAY
Mailing Address - Street 2:SUITE 180
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-8044
Mailing Address - Country:US
Mailing Address - Phone:936-447-9484
Mailing Address - Fax:936-447-9497
Practice Address - Street 1:1755 WOODSTEAD CT STE 100
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-0964
Practice Address - Country:US
Practice Address - Phone:936-447-9484
Practice Address - Fax:936-447-9497
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8103111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX042300601Medicaid
TXU72853Medicare UPIN
TX83875JMedicare PIN
TX042300601Medicaid