Provider Demographics
NPI:1447343702
Name:KEEN, JUSTIN MARK (DC)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:MARK
Last Name:KEEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OK
Mailing Address - Zip Code:73737-1618
Mailing Address - Country:US
Mailing Address - Phone:580-227-3515
Mailing Address - Fax:580-227-3667
Practice Address - Street 1:301 W ELM ST
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:OK
Practice Address - Zip Code:73737-1618
Practice Address - Country:US
Practice Address - Phone:580-227-3515
Practice Address - Fax:580-227-3667
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2433111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician