Provider Demographics
NPI:1386844561
Name:KERSHAW, PAMELA ELYSE (DC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ELYSE
Last Name:KERSHAW
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2691 ENGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7185
Mailing Address - Country:US
Mailing Address - Phone:321-242-5772
Mailing Address - Fax:321-951-1004
Practice Address - Street 1:2060 PALM BAY RD NE STE 5
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-2931
Practice Address - Country:US
Practice Address - Phone:321-591-7450
Practice Address - Fax:321-951-1004
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006237111N00000X
NY6125111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH0006237OtherFL LICENSE
NY6125OtherNY LICENSE
FL22618Medicare PIN
FLU12325Medicare UPIN