Provider Demographics
NPI:1376732321
Name:KERSTEN, BRAD RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:RYAN
Last Name:KERSTEN
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 1:1800 E MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-3821
Mailing Address - Country:US
Mailing Address - Phone:701-663-2700
Mailing Address - Fax:701-663-8175
Practice Address - Street 1:1800 E MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-3821
Practice Address - Country:US
Practice Address - Phone:701-663-2700
Practice Address - Fax:701-663-8175
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5030111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO803760Medicare PIN
COU87410Medicare UPIN
CO803759Medicare PIN