Provider Demographics
NPI:1295973535
Name:KEOUGH, FELICITY M (DC)
Entity type:Individual
Prefix:DR
First Name:FELICITY
Middle Name:M
Last Name:KEOUGH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:FELICITY
Other - Middle Name:MAE
Other - Last Name:KEOUGH-BLIGH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:2440 EXECUTIVE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-5607
Mailing Address - Country:US
Mailing Address - Phone:636-244-4994
Mailing Address - Fax:636-244-3134
Practice Address - Street 1:2440 EXECUTIVE DR STE 100
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-5607
Practice Address - Country:US
Practice Address - Phone:636-244-4994
Practice Address - Fax:636-244-3134
Is Sole Proprietor?:No
Enumeration Date:2009-01-24
Last Update Date:2021-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9657111N00000X
MO2009039678111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor