Provider Demographics
NPI:1114546942
Name:KEOGH, THOMAS LEROY IV (DC)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:LEROY
Last Name:KEOGH
Suffix:IV
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:THOMAS
Other - Middle Name:LEROY
Other - Last Name:KEOGH
Other - Suffix:IV
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:3839 GRAND AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-7650
Mailing Address - Country:US
Mailing Address - Phone:419-215-4326
Mailing Address - Fax:
Practice Address - Street 1:3839 GRAND AVE STE 5
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-7650
Practice Address - Country:US
Practice Address - Phone:419-215-4326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-12
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0008087111N00000X
MTCHI-CHI-LIC-7328111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor