Provider Demographics
NPI:1912039082
Name:O'KEEFE, SHANNON ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:ANN
Last Name:O'KEEFE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:SHANNON
Other - Middle Name:ANN
Other - Last Name:O'KEEFE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1053 ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-7004
Mailing Address - Country:US
Mailing Address - Phone:651-292-8072
Mailing Address - Fax:651-292-8722
Practice Address - Street 1:1053 ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-7004
Practice Address - Country:US
Practice Address - Phone:651-292-8072
Practice Address - Fax:651-292-8722
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3009111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN202717800Medicaid
MN223M6OKOtherBLUE CROSS BLUE SHLIED
MN223M6OKOtherBLUE CROSS BLUE SHLIED