Provider Demographics
NPI:1710146428
Name:BERNARD J KEENUM DC INC
Entity Type:Organization
Organization Name:BERNARD J KEENUM DC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KEENUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:850-501-7046
Mailing Address - Street 1:3100 BELLE MEADE DR
Mailing Address - Street 2:APT A
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503
Mailing Address - Country:US
Mailing Address - Phone:850-501-7046
Mailing Address - Fax:
Practice Address - Street 1:4711 SCENIC HIGHWAY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504
Practice Address - Country:US
Practice Address - Phone:850-501-7046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9285111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty