Provider Demographics
NPI:1063500460
Name:STERN, KENNETH HOWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:HOWARD
Last Name:STERN
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 1:13550 LORAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-3434
Mailing Address - Country:US
Mailing Address - Phone:216-476-1300
Mailing Address - Fax:216-476-1950
Practice Address - Street 1:13550 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-3434
Practice Address - Country:US
Practice Address - Phone:216-431-4700
Practice Address - Fax:216-671-5177
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-01866111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1679610687OtherNPI-GROUP
OH1063500460OtherNPI-INDIVIDUAL