Provider Demographics
NPI:1326013889
Name:KIESINER, KERRY (DC)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:
Last Name:KIESINER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:
Other - Last Name:KAGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:450 JEFFERSON DR UNIT 303
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-9450
Mailing Address - Country:US
Mailing Address - Phone:404-819-2284
Mailing Address - Fax:954-573-7454
Practice Address - Street 1:1121 1/2 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-2309
Practice Address - Country:US
Practice Address - Phone:931-735-6160
Practice Address - Fax:931-735-6290
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-20
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007131111N00000X
FLCH10913111N00000X
TN3019111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
V93192Medicare UPIN