Provider Demographics
NPI:1558501254
Name:KOERNER, KENNETH J (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:J
Last Name:KOERNER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JOEY
Other - Middle Name:
Other - Last Name:KOERNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1504 VINE ST
Mailing Address - Street 2:STE. B
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-3455
Mailing Address - Country:US
Mailing Address - Phone:785-628-2105
Mailing Address - Fax:785-628-2165
Practice Address - Street 1:1504 VINE ST
Practice Address - Street 2:STE. B
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-3455
Practice Address - Country:US
Practice Address - Phone:785-628-2105
Practice Address - Fax:785-628-2165
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05244111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor