Provider Demographics
NPI:1699807412
Name:KEHRES, STEVEN GERARD (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:GERARD
Last Name:KEHRES
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 1:968 E ROLLINS RD
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE BEACH
Mailing Address - State:IL
Mailing Address - Zip Code:60073-2247
Mailing Address - Country:US
Mailing Address - Phone:847-223-1220
Mailing Address - Fax:847-223-1271
Practice Address - Street 1:968 E ROLLINS RD
Practice Address - Street 2:
Practice Address - City:ROUND LAKE BEACH
Practice Address - State:IL
Practice Address - Zip Code:60073-2247
Practice Address - Country:US
Practice Address - Phone:847-223-1220
Practice Address - Fax:847-223-1271
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
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL973600Medicare ID - Type Unspecified