Provider Demographics
NPI:1134211519
Name:KEEGAN, KEVIN THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:THOMAS
Last Name:KEEGAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:MR
Other - First Name:KEVIN
Other - Middle Name:
Other - Last Name:KEEGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:990 MAIN ST.
Mailing Address - Street 2:SUITE 3
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818
Mailing Address - Country:US
Mailing Address - Phone:401-885-7992
Mailing Address - Fax:
Practice Address - Street 1:990 MAIN ST.
Practice Address - Street 2:SUITE 3
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818
Practice Address - Country:US
Practice Address - Phone:401-885-7992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI053101YM0800X
RIDCP00262111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI359009009OtherGROUP PTAN/PAY-TO-PROVIDE