Provider Demographics
NPI:1972780914
Name:KEIRAN CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:KEIRAN CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KEIRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:781-582-0400
Mailing Address - Street 1:82 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02364
Mailing Address - Country:US
Mailing Address - Phone:781-582-0400
Mailing Address - Fax:781-582-0402
Practice Address - Street 1:82 MAIN ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:MA
Practice Address - Zip Code:02364-2298
Practice Address - Country:US
Practice Address - Phone:781-582-0400
Practice Address - Fax:781-582-0402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA224111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY39953OtherBLUE CROSS BLUE SHIELD
MAY39953OtherBLUE CROSS BLUE SHIELD