Healthcare Provider Details

I. General information

NPI: 1417256215
Provider Name (Legal Business Name): JOHN H KEEFE III DC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2011
Last Update Date: 03/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5016 S 79TH EAST AVE
TULSA OK
74145-6003
US

IV. Provider business mailing address

5016 S 79TH EAST AVE
TULSA OK
74145-6003
US

V. Phone/Fax

Practice location:
  • Phone: 918-663-1111
  • Fax: 918-663-2129
Mailing address:
  • Phone: 918-663-1111
  • Fax: 918-663-2129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1769
License Number StateOK

VIII. Authorized Official

Name: DR. JOHN HORACE KEEFE III
Title or Position: CEO
Credential: DC
Phone: 918-663-1111