Provider Demographics
NPI:1851332340
Name:KEARSTAN, KENNETH M (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:M
Last Name:KEARSTAN
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 1:373 E MAIN ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-3143
Mailing Address - Country:US
Mailing Address - Phone:908-526-5868
Mailing Address - Fax:908-253-9826
Practice Address - Street 1:373 E MAIN ST
Practice Address - Street 2:SUITE 10
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-3143
Practice Address - Country:US
Practice Address - Phone:908-526-5868
Practice Address - Fax:908-253-9826
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00541500111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2178813OtherUNITED HEALTH CARE
NJ7931030OtherAETNA
NJP2559619OtherOXFORD
NJ7931030OtherAETNA