Provider Demographics
NPI:1891814596
Name:KERR, BEVERLY J (DC)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:J
Last Name:KERR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 16TH ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-3613
Mailing Address - Country:US
Mailing Address - Phone:812-279-6667
Mailing Address - Fax:812-279-6667
Practice Address - Street 1:1705 16TH ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-3613
Practice Address - Country:US
Practice Address - Phone:812-279-6667
Practice Address - Fax:812-279-6667
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001264A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN494350Medicare ID - Type Unspecified