Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 5692 | OR |
NPI | 1124492210 |
---|---|
Provider Name | Dr. Kellin David Keesee |
First Address | Lake Oswego, OR 97035-2625 |
Second Address | Lake Oswego, OR 97035-2625 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2015 |
Last Update Date | 09/05/2017 |