Provider Demographics
NPI:1821209222
Name:KERR, M DEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:M
Middle Name:DEAN
Last Name:KERR
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 1:13039 SEVENTH ST
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-4112
Mailing Address - Country:US
Mailing Address - Phone:909-627-3633
Mailing Address - Fax:
Practice Address - Street 1:13039 7TH ST
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-4112
Practice Address - Country:US
Practice Address - Phone:909-627-3633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11002111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2243227Medicaid
CA2243227Medicaid