Provider Demographics
NPI:1609423052
Name:KEEVA, AIDAN (DACM, LIC AC, MAOM)
Entity Type:Individual
Prefix:
First Name:AIDAN
Middle Name:
Last Name:KEEVA
Suffix:
Gender:M
Credentials:DACM, LIC AC, MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 ASHER CT
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-8444
Mailing Address - Country:US
Mailing Address - Phone:517-351-9240
Mailing Address - Fax:
Practice Address - Street 1:2045 ASHER CT
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8444
Practice Address - Country:US
Practice Address - Phone:517-351-9240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5401000270171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist