Provider Demographics
NPI:1528199403
Name:KERN, STEVEN A (DC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:A
Last Name:KERN
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 1:260 S PARKER ST
Mailing Address - Street 2:
Mailing Address - City:MARINE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48039-3502
Mailing Address - Country:US
Mailing Address - Phone:810-765-9700
Mailing Address - Fax:810-765-5825
Practice Address - Street 1:260 S PARKER ST
Practice Address - Street 2:
Practice Address - City:MARINE CITY
Practice Address - State:MI
Practice Address - Zip Code:48039-3502
Practice Address - Country:US
Practice Address - Phone:810-765-9700
Practice Address - Fax:810-765-5825
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISK005582111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2722005Medicaid
MI2722005Medicaid