Healthcare Provider Details

I. General information

NPI: 1760928626
Provider Name (Legal Business Name): JESSICA L KEATING DC, ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA L LODAL DC, ND

II. Dates (important events)

Enumeration Date: 01/16/2017
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1053 S NORBURY AVE
LOMBARD IL
60148-3924
US

IV. Provider business mailing address

1053 S NORBURY AVE
LOMBARD IL
60148-3924
US

V. Phone/Fax

Practice location:
  • Phone: 708-856-6954
  • Fax:
Mailing address:
  • Phone: 708-856-6954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.013067
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: