Healthcare Provider Details

I. General information

NPI: 1790727824
Provider Name (Legal Business Name): JOHN HORACE KEEFE III DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
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 TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1769
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number1769
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: