Provider Demographics
NPI:1093368755
Name:KERN, KAILEY FARGO (DC)
Entity Type:Individual
Prefix:DR
First Name:KAILEY
Middle Name:FARGO
Last Name:KERN
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 1:3400 W 66TH ST STE 128
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2109
Mailing Address - Country:US
Mailing Address - Phone:952-698-7277
Mailing Address - Fax:952-835-4723
Practice Address - Street 1:3400 W 66TH ST STE 128
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2109
Practice Address - Country:US
Practice Address - Phone:952-835-6750
Practice Address - Fax:952-835-4723
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6622111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor