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1114546942 NPI number — THOMAS LEROY KEOGH IV DC

NPI Number: 1114546942
Health Care Provider/Practitioner: THOMAS LEROY KEOGH IV DC

Information about “1114546942” NPI (THOMAS LEROY KEOGH IV DC) exists in 1114546942 in HTML format HTML  |  1114546942 in plain Text format TXT  |  1114546942 in PDF (Portable Document Format) PDF  |  1114546942 in an XML format XML  formats.

NPI Number : 1114546942 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1114546942",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KEOGH",
    "FirstName": "THOMAS",
    "MiddleName": "LEROY",
    "NamePrefix": "MR.",
    "NameSuffix": "IV",
    "Credential": "DC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "KEOGH",
    "OtherFirstName": "THOMAS",
    "OtherMiddleName": "LEROY",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": "IV",
    "OtherCredential": "DC",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "3839 GRAND AVE STE 5",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BILLINGS",
    "MailingAddressStateName": "MT",
    "MailingAddressPostalCode": "59102-7650",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "419-215-4326",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3839 GRAND AVE STE 5",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BILLINGS",
    "PracticeLocationAddressStateName": "MT",
    "PracticeLocationAddressPostalCode": "59102-7650",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "419-215-4326",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/12/2020",
    "LastUpdateDate": "10/05/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "111N00000X",
          "TaxonomyName": "Chiropractor",
          "LicenseNumber": "CHR.0008087",
          "LicenseNumberStateCode": "CO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "111N00000X",
          "TaxonomyName": "Chiropractor",
          "LicenseNumber": "CHI-CHI-LIC-7328",
          "LicenseNumberStateCode": "MT",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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