Provider Demographics
NPI:1821025156
Name:KERZNER, DANIEL W (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:W
Last Name:KERZNER
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 1:183 BOSTON POST R2, P.O. 868
Mailing Address - Street 2:
Mailing Address - City:EAST LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06333
Mailing Address - Country:US
Mailing Address - Phone:860-739-7004
Mailing Address - Fax:860-739-4791
Practice Address - Street 1:183 BOSTON POST R2
Practice Address - Street 2:
Practice Address - City:EAST LYME
Practice Address - State:CT
Practice Address - Zip Code:06333
Practice Address - Country:US
Practice Address - Phone:860-739-7004
Practice Address - Fax:860-739-4791
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT867111NS0005X, 111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004111837Medicaid
CT008045569Medicaid
CT1821025156OtherNPI
CT008045569Medicaid
CT004111837Medicaid