Provider Demographics
NPI:1770737553
Name:BEAR, KEVIN L (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:L
Last Name:BEAR
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 1:360 N MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:IN
Mailing Address - Zip Code:46714-2041
Mailing Address - Country:US
Mailing Address - Phone:260-353-1400
Mailing Address - Fax:260-353-1401
Practice Address - Street 1:360 N MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:IN
Practice Address - Zip Code:46714-2041
Practice Address - Country:US
Practice Address - Phone:260-353-1400
Practice Address - Fax:260-353-1401
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002402A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN259160AMedicare PIN