Provider Demographics
NPI:1972671097
Name:KERWIN, KENNETH J (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:J
Last Name:KERWIN
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 1:8081 W LAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-3712
Mailing Address - Country:US
Mailing Address - Phone:414-282-9001
Mailing Address - Fax:414-282-4140
Practice Address - Street 1:8081 W LAYTON AVE
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-3712
Practice Address - Country:US
Practice Address - Phone:414-282-9001
Practice Address - Fax:414-282-4140
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3271111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
000075860Medicare ID - Type Unspecified
U56885Medicare UPIN