Provider Demographics
NPI:1598001489
Name:TIMOTHY J KEYES JR DC LLC
Entity Type:Organization
Organization Name:TIMOTHY J KEYES JR DC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:KEYES
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:440-248-5070
Mailing Address - Street 1:6175 SOM CENTER RD
Mailing Address - Street 2:STE 140
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-2965
Mailing Address - Country:US
Mailing Address - Phone:440-248-5070
Mailing Address - Fax:440-498-4620
Practice Address - Street 1:6175 SOM CENTER RD
Practice Address - Street 2:STE 140
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2965
Practice Address - Country:US
Practice Address - Phone:440-248-5070
Practice Address - Fax:440-498-4620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3639111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty