Provider Demographics
NPI:1306916994
Name:HOURIHAN, KEITH MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:MICHAEL
Last Name:HOURIHAN
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 1:6755 MIRA MESA BLVD
Mailing Address - Street 2:SUITE #140
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-4392
Mailing Address - Country:US
Mailing Address - Phone:858-457-1925
Mailing Address - Fax:858-457-1927
Practice Address - Street 1:6755 MIRA MESA BLVD
Practice Address - Street 2:SUITE #140
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4392
Practice Address - Country:US
Practice Address - Phone:858-457-1925
Practice Address - Fax:858-457-1927
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29314111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWDC29314AMedicare ID - Type Unspecified
CAU97128Medicare UPIN