Provider Demographics
NPI:1609839489
Name:KEEFE, ADAM JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:JOHN
Last Name:KEEFE
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 1:1920 CENTERVILLE TPKE
Mailing Address - Street 2:STE. 95
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-6800
Mailing Address - Country:US
Mailing Address - Phone:757-479-0626
Mailing Address - Fax:757-479-8855
Practice Address - Street 1:1920 CENTERVILLE TPKE
Practice Address - Street 2:STE. 95
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-6800
Practice Address - Country:US
Practice Address - Phone:757-479-0626
Practice Address - Fax:757-479-8855
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555963111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA06-1649498OtherTAX ID
VA288958OtherANTHEM/BCBS PROV. #
VA06-1649498OtherTAX ID
VAU63415Medicare UPIN
VAC08548Medicare ID - Type UnspecifiedPROVIDER NUMBER