Provider Demographics
NPI:1245385608
Name:SEVERIN, KERRY M (DC)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:M
Last Name:SEVERIN
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 1:2602 ABBEY CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-6023
Mailing Address - Country:US
Mailing Address - Phone:770-667-6077
Mailing Address - Fax:770-667-6079
Practice Address - Street 1:2602 ABBEY CT
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-6023
Practice Address - Country:US
Practice Address - Phone:770-667-6077
Practice Address - Fax:770-667-6079
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR003129111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor