Individual provider Active NPI

Michael Jay Keenan, D.C.

  • Chiropractor
  • Bonita Springs, FL
National Provider Identifier
1669446795
Registry record updated Aug 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH8224 Issued in FL
Practice address
3388 Woods Edge Cir
Suite 102
Bonita Springs, FL 34134-1368
Phone
(239) 949-0220
Fax
(239) 949-0244
NPI assigned
Feb 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH8224 FL Primary

Addresses

Primary practice location

3388 Woods Edge Cir
Suite 102
Bonita Springs, FL 34134-1368

Mailing address

3388 Woods Edge Cir
Suite 102
Bonita Springs, FL 34134-1368
Phone (239) 949-0220

Other identifiers 1

IdentifierTypeStateIssuer
381583800MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1139961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314576000000",
    "number": "1669446795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3388 WOODS EDGE CIR",
            "address_2": "SUITE 102",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341341368",
            "telephone_number": "239-949-0220",
            "fax_number": "239-949-0244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3388 WOODS EDGE CIR",
            "address_2": "SUITE 102",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341341368",
            "telephone_number": "239-949-0220",
            "fax_number": "239-949-0244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEENAN",
        "first_name": "MICHAEL",
        "middle_name": "JAY",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-15",
        "last_updated": "2011-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH8224",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "381583800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bonita Springs, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2011; 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.