Provider Demographics
NPI:1053594382
Name:KEIRAN CHIROPRACTIC, P.A.
Entity type:Organization
Organization Name:KEIRAN CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:KEIRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-897-2332
Mailing Address - Street 1:259 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:ME
Mailing Address - Zip Code:04239
Mailing Address - Country:US
Mailing Address - Phone:207-897-2332
Mailing Address - Fax:207-897-3933
Practice Address - Street 1:259 MAIN STREET
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:ME
Practice Address - Zip Code:04239-0000
Practice Address - Country:US
Practice Address - Phone:207-897-2332
Practice Address - Fax:207-897-3933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1481111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEUX7739OtherMEDICARE PTAN
ME1391Medicare PIN