Provider Demographics
NPI:1235255241
Name:MCMURTRIE, KERN G (DC)
Entity Type:Individual
Prefix:DR
First Name:KERN
Middle Name:G
Last Name:MCMURTRIE
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 1:936 CHESTERFIELD PKWY E
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-2042
Mailing Address - Country:US
Mailing Address - Phone:636-537-0564
Mailing Address - Fax:636-537-2315
Practice Address - Street 1:936 CHESTERFIELD PKWY E
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-2042
Practice Address - Country:US
Practice Address - Phone:636-537-0564
Practice Address - Fax:636-537-2315
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO149490OtherBCBS PROVIDER NUMBER
MOU86235Medicare UPIN