Provider Demographics
NPI:1528407756
Name:KEOGH, MICAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:MICAEL
Middle Name:
Last Name:KEOGH
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 1:4035 TOURO ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-3140
Mailing Address - Country:US
Mailing Address - Phone:504-286-7808
Mailing Address - Fax:504-286-1136
Practice Address - Street 1:4035 TOURO ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-3140
Practice Address - Country:US
Practice Address - Phone:504-286-7808
Practice Address - Fax:504-286-1136
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA843111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor