Provider Demographics
NPI:1770641730
Name:KEEHN, STEPHEN R (DC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
Last Name:KEEHN
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 1:505 CEDAR AVE STE C3
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-4561
Mailing Address - Country:US
Mailing Address - Phone:360-659-8411
Mailing Address - Fax:
Practice Address - Street 1:505 CEDAR AVE STE C3
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4561
Practice Address - Country:US
Practice Address - Phone:360-659-8411
Practice Address - Fax:360-658-1033
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001023111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAR72020OtherREGENCE
WA2568103Medicaid
WA33694OtherLABOR AND INDUSTRIES