=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558435701
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHAWN D KEEGAN P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2006
-----------------------------------------------------
Last Update Date | 05/18/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 44355 PREMIER PLZ SUITE 130
-----------------------------------------------------
City | ASHBURN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20147-5049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-858-3500
-----------------------------------------------------
Fax | 703-858-9984
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 44355 PREMIER PLZ SUITE 130
-----------------------------------------------------
City | ASHBURN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20147-5049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-858-3500
-----------------------------------------------------
Fax | 703-858-9984
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT OWNER
-----------------------------------------------------
Name | DR. SHAWN D KEEGAN
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 703-858-3500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 0104001716
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------