Provider Demographics
NPI:1770666778
Name:KEREW, LYNN (DC, MPH)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:
Last Name:KEREW
Suffix:
Gender:F
Credentials:DC, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 251736
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-9125
Mailing Address - Country:US
Mailing Address - Phone:310-399-0337
Mailing Address - Fax:310-399-3944
Practice Address - Street 1:3435 OCEAN PARK BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-3316
Practice Address - Country:US
Practice Address - Phone:310-399-0337
Practice Address - Fax:310-399-3944
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24153111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU60964Medicare UPIN
CADC24153Medicare ID - Type Unspecified