Provider Demographics
NPI:1033218805
Name:KERSEY, DEBORAH RENEE (DC)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:RENEE
Last Name:KERSEY
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 1:1639 SOUTHSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1923
Mailing Address - Country:US
Mailing Address - Phone:904-725-2286
Mailing Address - Fax:904-725-4566
Practice Address - Street 1:1639 SOUTHSIDE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1923
Practice Address - Country:US
Practice Address - Phone:904-725-2286
Practice Address - Fax:904-725-4566
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 7909111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3380OtherMEDICARE GROUP #