Provider Demographics
NPI:1497995310
Name:MCKERNAN FAMILY CHIROPRACTIC CENTER P.C.
Entity Type:Organization
Organization Name:MCKERNAN FAMILY CHIROPRACTIC CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:MCKERNAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-532-1448
Mailing Address - Street 1:50544 SCHOENHERR RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-3134
Mailing Address - Country:US
Mailing Address - Phone:586-532-1448
Mailing Address - Fax:586-532-1472
Practice Address - Street 1:50544 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48315-3134
Practice Address - Country:US
Practice Address - Phone:586-532-1448
Practice Address - Fax:586-532-1472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008433111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI16350OtherM CARE
P31349 FOtherBLUE CARE NETWORK
MI950E05407OtherBLUE CROSS BLUE SHEILD
MI4685500Medicaid
MI485778OtherUMP
MICM008433OtherFIRST HEALTH
KERNANOtherHAP
MI950E05407OtherBLUE CROSS BLUE SHEILD