Healthcare Provider Details

I. General information

NPI: 1649398280
Provider Name (Legal Business Name): BARBARA KECK D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3504 GRAND BLVD
BROOKFIELD IL
60513-1302
US

IV. Provider business mailing address

4131 FOREST AVE
BROOKFIELD IL
60513-2125
US

V. Phone/Fax

Practice location:
  • Phone: 708-308-8314
  • Fax: 708-485-7003
Mailing address:
  • Phone: 708-308-8314
  • Fax: 708-485-7003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: