Healthcare Provider Details

I. General information

NPI: 1801892922
Provider Name (Legal Business Name): STEVEN LEE KEOGH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 VANROOY DRIVE
THIEF RIVER FALLS MN
56701-2007
US

IV. Provider business mailing address

1140 VANROOY DRIVE
THIEF RIVER FALLS MN
56701-2007
US

V. Phone/Fax

Practice location:
  • Phone: 218-681-2225
  • Fax: 218-681-4655
Mailing address:
  • Phone: 218-681-2225
  • Fax: 218-681-4655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1618
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: