Provider Demographics
NPI:1699769943
Name:KEENAN, STEPHEN JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JOSEPH
Last Name:KEENAN
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 1:700 RESERVOIR AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-3237
Mailing Address - Country:US
Mailing Address - Phone:401-942-6020
Mailing Address - Fax:401-942-6178
Practice Address - Street 1:700 RESERVOIR AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-3237
Practice Address - Country:US
Practice Address - Phone:401-942-6020
Practice Address - Fax:401-942-6178
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI177111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI2468466OtherAETNA
RI9110-1OtherBLUE CROSS
RI201626OtherCHIP
RI44-00921OtherUNITED HEALTCARE
RIT53792Medicare UPIN