1336504000 NPI number — KEHRES HEALTH AND CHIROPRACTIC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336504000 NPI number — KEHRES HEALTH AND CHIROPRACTIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEHRES HEALTH AND CHIROPRACTIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336504000
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4805 TOWNE CENTRE RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
SAGINAW
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48604-2831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-607-4322
Provider Business Mailing Address Fax Number:
989-401-4555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4805 TOWNE CENTRE RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SAGINAW
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48604-2831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-607-4322
Provider Business Practice Location Address Fax Number:
989-401-4555
Provider Enumeration Date:
12/23/2015

Additional Information

Authorized Official

Authorized Official Last Name:
KEHRES
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
B
Authorized Official Title or Position:
DOCTOR OF CHIROPRACTIC
Authorized Official Telephone Number:
989-295-4357

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2301009633 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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