Provider Demographics
NPI:1043229636
Name:KERN, DEANNA MCCUTCHEON (DC)
Entity Type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:MCCUTCHEON
Last Name:KERN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:DEANNA
Other - Middle Name:MCCUTCHEON
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1960 COPPER MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:JUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:76247-6748
Mailing Address - Country:US
Mailing Address - Phone:214-529-0948
Mailing Address - Fax:
Practice Address - Street 1:4301 SATURN RD STE 201
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-5351
Practice Address - Country:US
Practice Address - Phone:214-275-7200
Practice Address - Fax:214-703-3354
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8834111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX08834OtherDC LICENSE