Provider Demographics
NPI:1700087939
Name:GOVER, KEITH BOWEN (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:BOWEN
Last Name:GOVER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28051 DEQUINDRE RD STE F
Mailing Address - Street 2:
Mailing Address - City:MADISON HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-3016
Mailing Address - Country:US
Mailing Address - Phone:248-733-5442
Mailing Address - Fax:248-963-6214
Practice Address - Street 1:28051 DEQUINDRE RD STE F
Practice Address - Street 2:
Practice Address - City:MADISON HTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3016
Practice Address - Country:US
Practice Address - Phone:248-733-5442
Practice Address - Fax:248-963-6214
Is Sole Proprietor?:No
Enumeration Date:2007-05-28
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006620111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOF32538OtherBLUE CROSS/BLUE SHIELD