Provider Demographics
NPI:1669446795
Name:KEENAN, MICHAEL JAY (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAY
Last Name:KEENAN
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 1:3388 WOODS EDGE CIR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-1368
Mailing Address - Country:US
Mailing Address - Phone:239-949-0220
Mailing Address - Fax:239-949-0244
Practice Address - Street 1:3388 WOODS EDGE CIR
Practice Address - Street 2:SUITE 102
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-1368
Practice Address - Country:US
Practice Address - Phone:239-949-0220
Practice Address - Fax:239-949-0244
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8224111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381583800Medicaid
FLU86011Medicare UPIN
FL381583800Medicaid