Healthcare Provider Details

I. General information

NPI: 1124492210
Provider Name (Legal Business Name): KELLIN DAVID KEESEE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2015
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 SE STEPHENS ST
PORTLAND OR
97214-4748
US

IV. Provider business mailing address

1111 SE STEPHENS ST
PORTLAND OR
97214-4748
US

V. Phone/Fax

Practice location:
  • Phone: 971-544-7058
  • Fax: 971-244-9058
Mailing address:
  • Phone: 971-544-7058
  • Fax: 971-244-9058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number5692
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: