Provider Demographics
NPI:1982644092
Name:KEIRAN, KATHLEEN M (DC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:KEIRAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02364-2298
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2167111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAUX8948OtherMEDICARE PTAN
MAUX8948OtherMEDICARE PTAN