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General NPI Number Information
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NPI Number | 1376163683
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Entity Type | Organization
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Legal Business Name | BERNARD KEENUM, LLC
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Dates
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Enumeration Date | 04/16/2020
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Last Update Date | 04/16/2020
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Provider Practice Location Address
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Address Line | 11505 CINEMA DR STE 7
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City | DIBERVILLE
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State | MS
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Zip | 39540-9703
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Country | US
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Telephone | 228-365-0449
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Fax | 228-365-2314
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Provider Business Mailing Address
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Address Line | 11505 CINEMA DR STE 7
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City | DIBERVILLE
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State | MS
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Zip | 39540-9703
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Country | US
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Telephone | 228-365-0449
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Fax | 228-365-2314
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. BERNARD JOSEPH KEENUM
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Credential | DC
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Telephone | 228-337-0440
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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 |
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License Number State |
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