Provider Demographics
NPI:1316019557
Name:KERSCHBAUM, CHANEL (RD, CPT)
Entity Type:Individual
Prefix:
First Name:CHANEL
Middle Name:
Last Name:KERSCHBAUM
Suffix:
Gender:F
Credentials:RD, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 FAIRWAY CT
Mailing Address - Street 2:
Mailing Address - City:PLAINWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49080-9122
Mailing Address - Country:US
Mailing Address - Phone:269-845-2558
Mailing Address - Fax:
Practice Address - Street 1:5886 VENTURE PARK
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-1848
Practice Address - Country:US
Practice Address - Phone:269-845-2558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered