Provider Demographics
NPI:1407988785
Name:KERCHANSKY, KEVIN MATTHEW (DC, FNP-C, DACRB)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MATTHEW
Last Name:KERCHANSKY
Suffix:
Gender:M
Credentials:DC, FNP-C, DACRB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29650 DEPT # 880391
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038
Mailing Address - Country:US
Mailing Address - Phone:480-626-1746
Mailing Address - Fax:480-626-2690
Practice Address - Street 1:6036 N 19TH AVE STE 204
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2104
Practice Address - Country:US
Practice Address - Phone:480-616-0356
Practice Address - Fax:480-616-0603
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3728111N00000X
AZ251086363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH11172882OtherCAQH #
OH3728OtherSTATE LICENSE NUMBER