Active NPI
Mark David Keele, DC
- Chiropractor
- Louisville, KY
National Provider Identifier
1659413193
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 4197
- Practice address
- 4011 Taylor Blvd
Louisville, KY 40215-2542 - Phone
- (502) 367-7114
- Fax
- (502) 367-7108
- NPI assigned
- Feb 13, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 4197 | KY | Primary |
Addresses
Primary practice location
4011 Taylor Blvd
Louisville, KY 40215-2542
Mailing address
4011 Taylor Blvd
Louisville, KY 40215-2542
Phone (502) 367-7114
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000051682 | Other | KY | ANTHEM BCBS |
| 1121409 | Other | KY | PASSPORT |
| 85041978 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060111000047 | KY | Practitioner - Chiropractic | 8628091196 | Practice locations: Louisville, KY |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4197 | KY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1659413193",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4011 TAYLOR BLVD",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402152542",
"telephone_number": "502-367-7114",
"fax_number": "502-367-7108"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4011 TAYLOR BLVD",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402152542",
"telephone_number": "502-367-7114",
"fax_number": "502-367-7108"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEELE",
"first_name": "MARK",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-13",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "KY",
"license": "4197",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BCBS",
"identifier": "000000051682",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PASSPORT",
"identifier": "1121409",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "85041978",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.