Provider Demographics
NPI:1114694411
Name:KERSTEN, JUSTIN (DC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:KERSTEN
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 1:942 MCLINDEN AVE SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-4142
Mailing Address - Country:US
Mailing Address - Phone:586-744-2802
Mailing Address - Fax:
Practice Address - Street 1:1834 S COBB INDUSTRIAL BLVD SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-4908
Practice Address - Country:US
Practice Address - Phone:404-594-5809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010493111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician