Provider Demographics
NPI:1609841071
Name:KERMEEN, KEITH L (DC)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:L
Last Name:KERMEEN
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-3405
Mailing Address - Country:US
Mailing Address - Phone:906-786-5520
Mailing Address - Fax:906-786-3529
Practice Address - Street 1:218 S 10TH ST
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-3405
Practice Address - Country:US
Practice Address - Phone:906-786-5520
Practice Address - Fax:906-786-3529
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2025-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKK004820111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950B15007OtherBLUE CROSS BLUE SHIELD
MI0B15007Medicare ID - Type UnspecifiedMEDICARE
MIT32703Medicare UPIN