Provider Demographics
NPI:1821844028
Name:KEESEY, DOMINIQUE JUSTINE (DC)
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:JUSTINE
Last Name:KEESEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70859 CHERMONT RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43912-9796
Mailing Address - Country:US
Mailing Address - Phone:740-827-0420
Mailing Address - Fax:
Practice Address - Street 1:700 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CADIZ
Practice Address - State:OH
Practice Address - Zip Code:43907-9498
Practice Address - Country:US
Practice Address - Phone:740-320-4022
Practice Address - Fax:740-320-4023
Is Sole Proprietor?:No
Enumeration Date:2024-04-29
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH05356111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor