Provider Demographics
NPI:1841358744
Name:KEEHN, MICHAEL L (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:KEEHN
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:PO BOX 1415
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270
Mailing Address - Country:US
Mailing Address - Phone:360-659-6241
Mailing Address - Fax:360-659-3918
Practice Address - Street 1:9516 STATE AVE
Practice Address - Street 2:STE D
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4301
Practice Address - Country:US
Practice Address - Phone:360-659-6241
Practice Address - Fax:360-659-3918
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002113111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2568103Medicaid
WA68088OtherLABOR AND INDUSTRIES
WAR70063OtherREGENCE
WA2568103Medicaid