Provider Demographics
NPI:1760654925
Name:KEENUM, BERNARD JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:JOSEPH
Last Name:KEENUM
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 1:11505 CINEMA DR STE 7
Mailing Address - Street 2:
Mailing Address - City:DIBERVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39540-9703
Mailing Address - Country:US
Mailing Address - Phone:228-365-0449
Mailing Address - Fax:228-365-2314
Practice Address - Street 1:11505 CINEMA DR STE 7
Practice Address - Street 2:
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-9703
Practice Address - Country:US
Practice Address - Phone:228-365-0449
Practice Address - Fax:228-365-2314
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS001221111N00000X
FLCH9285111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor