Provider Demographics
NPI:1710070073
Name:KEHOE, JOHN RICHARD (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RICHARD
Last Name:KEHOE
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 1:26555 CARMEL RANCHO BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93923-8748
Mailing Address - Country:US
Mailing Address - Phone:831-625-3338
Mailing Address - Fax:831-625-5613
Practice Address - Street 1:26555 CARMEL RANCHO BLVD STE 2
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93923-8748
Practice Address - Country:US
Practice Address - Phone:831-625-3338
Practice Address - Fax:831-625-5613
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14110111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA770005979OtherTIN
CADC0141100Medicare ID - Type Unspecified
CAT05245Medicare UPIN