Provider Demographics
NPI:1710135280
Name:KEASLER, JODI E (DC)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:E
Last Name:KEASLER
Suffix:
Gender:F
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:PO BOX 372
Mailing Address - Street 2:412 W MAIN
Mailing Address - City:TEXHOMA
Mailing Address - State:OK
Mailing Address - Zip Code:73949-9717
Mailing Address - Country:US
Mailing Address - Phone:580-461-4336
Mailing Address - Fax:
Practice Address - Street 1:910 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942-4021
Practice Address - Country:US
Practice Address - Phone:580-461-4336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3890111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor