Provider Demographics
NPI:1184933277
Name:KERN CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:KERN CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MCC
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:B
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-606-5914
Mailing Address - Street 1:4720 CLEVELAND HEIGHTS BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2243
Mailing Address - Country:US
Mailing Address - Phone:863-606-5914
Mailing Address - Fax:863-606-5916
Practice Address - Street 1:4720 CLEVELAND HEIGHTS BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2243
Practice Address - Country:US
Practice Address - Phone:863-606-5914
Practice Address - Fax:863-606-5916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-07
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEI625AMedicare PIN