Provider Demographics
NPI:1619047685
Name:KEOGH, GEORGE PETER (DC)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:PETER
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 1:3901 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-4940
Mailing Address - Country:US
Mailing Address - Phone:253-756-7500
Mailing Address - Fax:253-756-7501
Practice Address - Street 1:3901 6TH AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-4940
Practice Address - Country:US
Practice Address - Phone:253-756-7500
Practice Address - Fax:253-756-7501
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033867111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2029163Medicaid
WA8867767Medicare PIN
WAU73380Medicare UPIN