NPIMap

Organization Active NPI

Keough Chiropractic, Inc

  • Chiropractor
  • Grand Terrace, CA
National Provider Identifier
1104026913
Registry record updated Oct 31, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
KEOUGH CHIROPRACTIC, INC
Practice address
12139 Mount Vernon Ave Ste 100
Grand Terrace, CA 92313-5519
Phone
(909) 783-4950
Fax
(909) 783-1008
NPI assigned
Jul 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Kelly Patrick Keough, DC
Title
President
Phone
(909) 783-4950

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X Primary

Addresses

Primary practice location

12139 Mount Vernon Ave Ste 100
Grand Terrace, CA 92313-5519

Mailing address

12139 Mount Vernon Ave Ste 100
Grand Terrace, CA 92313-5519
Phone (909) 783-4950

National Provider Directory

National Provider Directory

Locations

12139 Mount Vernon Ave
Ste 100
Grand Terrace, CA 92313
Phone (909) 783-4950

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225411200000",
    "number": "1104026913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12139 MOUNT VERNON AVE STE 100",
            "city": "GRAND TERRACE",
            "state": "CA",
            "postal_code": "923135519",
            "telephone_number": "909-783-4950",
            "fax_number": "909-783-1008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12139 MOUNT VERNON AVE STE 100",
            "city": "GRAND TERRACE",
            "state": "CA",
            "postal_code": "923135519",
            "telephone_number": "909-783-4950",
            "fax_number": "909-783-1008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEOUGH CHIROPRACTIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-19",
        "last_updated": "2008-10-31",
        "status": "A",
        "authorized_official_last_name": "KEOUGH",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-783-4950",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Terrace, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.