Provider Demographics
NPI:1699944744
Name:KEENAN, JOHN MACKENZIE (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MACKENZIE
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 1:718 LERAY ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-1311
Mailing Address - Country:US
Mailing Address - Phone:315-788-5433
Mailing Address - Fax:315-788-5433
Practice Address - Street 1:718 LERAY ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-1311
Practice Address - Country:US
Practice Address - Phone:315-788-5433
Practice Address - Fax:315-788-5433
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005776-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor