Provider Demographics
NPI:1760931497
Name:KERSHEN HEALTH SERVICES
Entity Type:Organization
Organization Name:KERSHEN HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:R
Authorized Official - Last Name:KERSHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:806-655-8777
Mailing Address - Street 1:1613 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79015
Mailing Address - Country:US
Mailing Address - Phone:806-655-8777
Mailing Address - Fax:806-655-8790
Practice Address - Street 1:1613 4TH AVE
Practice Address - Street 2:
Practice Address - City:CANYON
Practice Address - State:TX
Practice Address - Zip Code:79015
Practice Address - Country:US
Practice Address - Phone:806-655-8777
Practice Address - Fax:806-655-8790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111N00000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty