Provider Demographics
NPI:1801892922
Name:KEOGH, STEVEN LEE (DC)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:LEE
Last Name:KEOGH
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 1:1140 VANROOY DRIVE
Mailing Address - Street 2:
Mailing Address - City:THIEF RIVER FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56701-2007
Mailing Address - Country:US
Mailing Address - Phone:218-681-2225
Mailing Address - Fax:218-681-4655
Practice Address - Street 1:1140 VANROOY DRIVE
Practice Address - Street 2:
Practice Address - City:THIEF RIVER FALLS
Practice Address - State:MN
Practice Address - Zip Code:56701-2007
Practice Address - Country:US
Practice Address - Phone:218-681-2225
Practice Address - Fax:218-681-4655
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1618111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN645027000OtherMEDICAL ASSISTANCE
MN0909OtherPREFEREDONE
MN00B02ALOtherBLUE CROSS
MN350001708Medicare UPIN
MN00B02ALOtherBLUE CROSS