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General NPI Number Information
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NPI Number | 1114546942
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Entity Type | Individual
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Provider Name | THOMAS LEROY KEOGH IV DC
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Gender | Male
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Dates
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Enumeration Date | 04/12/2020
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 3839 GRAND AVE STE 5
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City | BILLINGS
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State | MT
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Zip | 59102-7650
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Country | US
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Telephone | 419-215-4326
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Fax |
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Provider Business Mailing Address
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Address Line | 3839 GRAND AVE STE 5
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City | BILLINGS
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State | MT
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Zip | 59102-7650
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Country | US
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Telephone | 419-215-4326
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHR.0008087
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHI-CHI-LIC-7328
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License Number State | MT
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