Provider Demographics
NPI:1902199177
Name:JEFFREY J KEON & DINA J KEON, A CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:JEFFREY J KEON & DINA J KEON, A CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KEON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:916-487-3008
Mailing Address - Street 1:1260 FULTON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-7396
Mailing Address - Country:US
Mailing Address - Phone:916-487-3008
Mailing Address - Fax:916-487-1197
Practice Address - Street 1:2025 HURLEY WAY STE 110
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-3225
Practice Address - Country:US
Practice Address - Phone:916-487-3008
Practice Address - Fax:916-487-1197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-20
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25579261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center