Provider Demographics
NPI:1124492210
Name:KEESEE, KELLIN DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:KELLIN
Middle Name:DAVID
Last Name:KEESEE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4847 MEADOWS RD
Mailing Address - Street 2:SUITE 153
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-2625
Mailing Address - Country:US
Mailing Address - Phone:971-330-8578
Mailing Address - Fax:
Practice Address - Street 1:4847 MEADOWS RD
Practice Address - Street 2:SUITE 153
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-2625
Practice Address - Country:US
Practice Address - Phone:971-330-8578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-30
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5692111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician