Provider Demographics
NPI:1336492594
Name:CARON, KEVIN RALPH (DC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:RALPH
Last Name:CARON
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 1:27322 23 MILE RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051-2032
Mailing Address - Country:US
Mailing Address - Phone:586-598-9120
Mailing Address - Fax:
Practice Address - Street 1:27322 23 MILE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-2032
Practice Address - Country:US
Practice Address - Phone:586-598-9120
Practice Address - Fax:586-598-9155
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010029111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor