Provider Demographics
NPI:1699827485
Name:KEENEY, BRADLEY JEROME (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:JEROME
Last Name:KEENEY
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 1:6200 W 9TH ST
Mailing Address - Street 2:UNIT 2A
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-4462
Mailing Address - Country:US
Mailing Address - Phone:970-353-0337
Mailing Address - Fax:
Practice Address - Street 1:6200 W 9TH ST
Practice Address - Street 2:UNIT 2A
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4462
Practice Address - Country:US
Practice Address - Phone:970-353-0337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2928111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO18706Medicare UPIN
CO26193Medicare ID - Type UnspecifiedMEDICARE NUMBER