Provider Demographics
NPI:1932477940
Name:KEOGH, JESSE DANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:DANIEL
Last Name:KEOGH
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 1:309 27TH ST NW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-2834
Mailing Address - Country:US
Mailing Address - Phone:701-852-0596
Mailing Address - Fax:701-852-0597
Practice Address - Street 1:309 27TH ST NW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-2834
Practice Address - Country:US
Practice Address - Phone:701-852-0596
Practice Address - Fax:701-852-0597
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND893111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor