Provider Demographics
NPI:1871782193
Name:KEENAN, MARK JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:JAMES
Last Name:KEENAN
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:PO BOX 23304
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15222-6304
Mailing Address - Country:US
Mailing Address - Phone:412-281-8283
Mailing Address - Fax:
Practice Address - Street 1:239 4TH AVE STE 1105
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222-1712
Practice Address - Country:US
Practice Address - Phone:412-281-8283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-006865-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor