Provider Demographics
NPI:1639372469
Name:KERN, GRAHAM W (DC)
Entity Type:Individual
Prefix:
First Name:GRAHAM
Middle Name:W
Last Name:KERN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4720 CLEVELAND HEIGHTS BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2243
Mailing Address - Country:US
Mailing Address - Phone:863-606-5914
Mailing Address - Fax:863-606-5916
Practice Address - Street 1:4720 CLEVELAND HEIGHTS BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2243
Practice Address - Country:US
Practice Address - Phone:863-606-5914
Practice Address - Fax:863-606-5916
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2010-11-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLCH9806111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDH836ZMedicare PIN