Provider Demographics
NPI:1023221421
Name:FOREMAN, KERRA DALE (DC)
Entity Type:Individual
Prefix:DR
First Name:KERRA
Middle Name:DALE
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1938 PALM DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-7805
Mailing Address - Country:US
Mailing Address - Phone:719-445-0711
Mailing Address - Fax:
Practice Address - Street 1:1938 PALM DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-7805
Practice Address - Country:US
Practice Address - Phone:719-445-0711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO920734980111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO841081956OtherTAX IDENTIFICATION