Provider Demographics
NPI:1770876138
Name:JAMES R. KEENE, PH.D., D.O., PS
Entity type:Organization
Organization Name:JAMES R. KEENE, PH.D., D.O., PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES./SECRETARY/TREAS./DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:KEENE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:5097-833-7444
Mailing Address - Street 1:50 DALTON LN
Mailing Address - Street 2:
Mailing Address - City:ZILLAH
Mailing Address - State:WA
Mailing Address - Zip Code:98953-9300
Mailing Address - Country:US
Mailing Address - Phone:509-961-5352
Mailing Address - Fax:
Practice Address - Street 1:5219 W CLEARWATER AVE
Practice Address - Street 2:SUITE 15
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-1914
Practice Address - Country:US
Practice Address - Phone:509-783-3744
Practice Address - Fax:509-736-0771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001639204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty