Provider Demographics
NPI:1336223213
Name:KEON, JEFFREY JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JOHN
Last Name:KEON
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 1:2025 HURLEY WAY STE 110
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-3225
Mailing Address - Country:US
Mailing Address - Phone:916-487-3008
Mailing Address - Fax:916-487-1197
Practice Address - Street 1:2025 HURLEY WAY STE 110
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-3225
Practice Address - Country:US
Practice Address - Phone:916-487-3008
Practice Address - Fax:916-487-1197
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25579111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU78892Medicare UPIN
CADC0255790Medicare ID - Type Unspecified