Provider Demographics
NPI:1497888952
Name:KERVICK, LINDSAY ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:LINDSAY
Middle Name:ANN
Last Name:KERVICK
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 1:25 PECKHAM PL # A
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809-2725
Mailing Address - Country:US
Mailing Address - Phone:401-253-4388
Mailing Address - Fax:
Practice Address - Street 1:935 PARK AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-2722
Practice Address - Country:US
Practice Address - Phone:401-941-7171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDC 296111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI3530-1OtherBCBS
RI204137OtherBLUECHIP