Provider Demographics
NPI:1790841005
Name:KEAN DC PC
Entity Type:Organization
Organization Name:KEAN DC PC
Other - Org Name:SIEGEL CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:M
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:252-259-1443
Mailing Address - Street 1:108 AVON AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-3841
Mailing Address - Country:US
Mailing Address - Phone:252-946-5101
Mailing Address - Fax:
Practice Address - Street 1:108 AVON AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3841
Practice Address - Country:US
Practice Address - Phone:252-946-5101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2937111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5922361Medicaid
DQ5842OtherMEDICARE RAIL ROAD
NC5922361Medicaid
NC6734940001Medicare NSC