Provider Demographics
NPI:1790128007
Name:KIERNAN CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:KIERNAN CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:KIERNAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:314-865-2450
Mailing Address - Street 1:2401 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-4345
Mailing Address - Country:US
Mailing Address - Phone:314-865-2450
Mailing Address - Fax:314-865-2450
Practice Address - Street 1:2401 S 11TH ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-4345
Practice Address - Country:US
Practice Address - Phone:314-865-2450
Practice Address - Fax:314-865-2450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty