Provider Demographics
NPI:1477525244
Name:MURKOWSKI, KENNETH SJ (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:SJ
Last Name:MURKOWSKI
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 1:645 SAINT CLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-2024
Mailing Address - Country:US
Mailing Address - Phone:517-784-9123
Mailing Address - Fax:517-784-9150
Practice Address - Street 1:645 SAINT CLAIR AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-2024
Practice Address - Country:US
Practice Address - Phone:517-784-9123
Practice Address - Fax:517-784-9150
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002595111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950C850180OtherBLUE CROSS PIN
MI1057984-14Medicaid
MI950C850180OtherBLUE CROSS PIN
MI0C85018-7952Medicare ID - Type Unspecified