Provider Demographics
NPI:1184051187
Name:KIM KEENE, D.C., P.A.
Entity type:Organization
Organization Name:KIM KEENE, D.C., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:KEENE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-914-6550
Mailing Address - Street 1:757 MALETA LN
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-7612
Mailing Address - Country:US
Mailing Address - Phone:720-885-3008
Mailing Address - Fax:720-733-2433
Practice Address - Street 1:757 MALETA LN
Practice Address - Street 2:SUITE 104
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-7612
Practice Address - Country:US
Practice Address - Phone:720-885-3008
Practice Address - Fax:720-733-2433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7220111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty