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General NPI Number Information
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NPI Number | 1790841005
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Entity Type | Organization
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Legal Business Name | KEAN DC PC
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 06/10/2013
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Provider Practice Location Address
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Address Line | 108 AVON AVE
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City | WASHINGTON
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State | NC
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Zip | 27889-3841
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Country | US
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Telephone | 252-946-5101
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Fax |
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Provider Business Mailing Address
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Address Line | 108 AVON AVE
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City | WASHINGTON
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State | NC
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Zip | 27889-3841
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Country | US
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Telephone | 252-946-5101
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SCOTT M SIEGEL
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Credential | D.C.
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Telephone | 252-259-1443
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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 | 2937
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License Number State | NC
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