Provider Demographics
NPI:1609883339
Name:KEYES, TIMOTHY JACOB JR (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JACOB
Last Name:KEYES
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6175 SOM CENTER ROAD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-2941
Mailing Address - Country:US
Mailing Address - Phone:440-248-5070
Mailing Address - Fax:440-498-4620
Practice Address - Street 1:6175 SOM CENTER ROAD
Practice Address - Street 2:SUITE 140
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2941
Practice Address - Country:US
Practice Address - Phone:440-248-5070
Practice Address - Fax:440-498-4620
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3639111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor