Provider Demographics
NPI:1861467383
Name:VON KERENS, DAVID J (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:VON KERENS
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 1:11314 Q ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-3679
Mailing Address - Country:US
Mailing Address - Phone:402-592-3060
Mailing Address - Fax:402-592-3363
Practice Address - Street 1:11314 Q ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-3679
Practice Address - Country:US
Practice Address - Phone:402-592-3060
Practice Address - Fax:402-592-3363
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-19
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE886111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE11922OtherMIDLANDS CHOICE
NE47069928000Medicaid
47099280OtherMUTUAL OF OMAHA
IA0599035Medicaid
NE09685NEOtherBLUECROSS/BLUESHIELD
350012724OtherRAILROAD MEDICARE
47099280OtherMUTUAL OF OMAHA
091559VONMedicare ID - Type Unspecified