Individual provider Active NPI

Kellin David Keesee, DC

  • Sports Physician Chiropractor
  • Portland, OR
National Provider Identifier
1124492210
Registry record updated Dec 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Physician ChiropractorTaxonomy code 111NS0005X
License
5692 Issued in OR
Practice address
1111 SE Stephens St
Portland, OR 97214-4748
Phone
(971) 544-7058
Fax
(971) 244-9058
NPI assigned
Nov 30, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Physician Chiropractor 111NS0005X 5692 OR Primary

Addresses

Primary practice location

1111 SE Stephens St
Portland, OR 97214-4748

Mailing address

1111 SE Stephens St
Portland, OR 97214-4748
Phone (971) 544-7058

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151222001916 OR Practitioner - Chiropractic 7214238971 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5692ORMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Care Chiropractic, LLC CurrentSince Dec 14, 2025 Accepting new patients

Locations

1111 SE Stephens St
Portland, OR 97214
Phone (503) 461-9664

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1448841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765411200000",
    "number": "1124492210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 SE STEPHENS ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972144748",
            "telephone_number": "971-544-7058",
            "fax_number": "971-244-9058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 SE STEPHENS ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972144748",
            "telephone_number": "971-544-7058",
            "fax_number": "971-244-9058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEESEE",
        "first_name": "KELLIN",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-11-30",
        "last_updated": "2025-12-11",
        "certification_date": "2025-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "OR",
            "license": "5692",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.