Provider Demographics
NPI:1679648612
Name:KEIM, RICHARD ALBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALBERT
Last Name:KEIM
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 1:1000 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-3230
Mailing Address - Country:US
Mailing Address - Phone:541-689-0935
Mailing Address - Fax:541-461-6884
Practice Address - Street 1:1000 RIVER RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-3230
Practice Address - Country:US
Practice Address - Phone:541-689-0935
Practice Address - Fax:541-461-6884
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2915111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR009726003OtherREGENCE BCBS
OR009726003OtherREGENCE BCBS
ORU56044Medicare UPIN
OR930615769OtherEIN
OR350048501Medicare ID - Type UnspecifiedPALMETTO GBA
ORR00WCJVRDMedicare ID - Type UnspecifiedNORIDIAN MEDICARE