Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038012191 | IL |
NPI | 1003176231 |
---|---|
Provider Name | Dr. Nicholas D Keim |
First Address | Shiloh, IL 62269-8917 |
Second Address | Shiloh, IL 62269-8917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2012 |
Last Update Date | 22/05/2012 |