Provider Demographics
NPI:1003073503
Name:MCKERNAN FAMILY CHIROPRACTIC CENTER, P.C.
Entity Type:Organization
Organization Name:MCKERNAN FAMILY CHIROPRACTIC CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:MCKERNAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-997-4086
Mailing Address - Street 1:51863 SCHOENHERR RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-2757
Mailing Address - Country:US
Mailing Address - Phone:586-997-4086
Mailing Address - Fax:586-997-6916
Practice Address - Street 1:51863 SCHOENHERR RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48315-2757
Practice Address - Country:US
Practice Address - Phone:586-997-4086
Practice Address - Fax:586-997-6916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008433111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950E05407OtherBCBSM
MI4685500Medicaid
MICM008433OtherCOMMERCIAL
MIU85778Medicare UPIN
MI0N65710Medicare PIN