Provider Demographics
NPI:1114917457
Name:KERN CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:KERN CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KERN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-765-9700
Mailing Address - Street 1:260 S PARKER ST
Mailing Address - Street 2:
Mailing Address - City:MARINE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48039-3502
Mailing Address - Country:US
Mailing Address - Phone:810-765-9700
Mailing Address - Fax:810-765-5825
Practice Address - Street 1:260 S PARKER ST
Practice Address - Street 2:
Practice Address - City:MARINE CITY
Practice Address - State:MI
Practice Address - Zip Code:48039-3502
Practice Address - Country:US
Practice Address - Phone:810-765-9700
Practice Address - Fax:810-765-5825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISK005582111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2722005Medicaid
MI950G410370OtherBLUE CROSS
MI950G410370OtherBLUE CROSS
MI2722005Medicaid