Kelly Patrick Keough, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

13815 Issued in CA

Practice address

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

Phone

(909) 783-4950

Fax

(909) 783-1008

NPI assigned

Jul 5, 2006

Last updated

Nov 4, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Keough Chiropractic, Inc

  • Chiropractor
  • Grand Terrace, CA
  • NPI 1104026913
  Authorized official Same address or phone
• Bissani Chiropractic and Integrated Health PC

  dba Grand Terrace Chiropractic

  • Clinic/Center
  • Grand Terrace, CA
  • NPI 1306457916
  NPD

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1225756800000",
    "number": "1407886153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1944 COUNTRY CLUB DR",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923737306",
            "telephone_number": "909-793-5700"
        },
        {
            "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": {
        "last_name": "KEOUGH",
        "first_name": "KELLY",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2008-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "13815",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole C Jones
• Robert Loyd Jung I, DDS
• Sharanjeet Kaur
• Sokdina Keo
• Keough Chiropractic, Inc
• Keystone NPS LLC
• Cheong Kim, PT
• Myungjin Kim, P.T.
• Cassidy Carina Liu Koo
• Emily Ruth Larsen, SLP

• Chiropractor in Grand Terrace, CA
• Providers in Grand Terrace, CA by specialty
• Chiropractor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 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.