1003073503 NPI number — MCKERNAN FAMILY CHIROPRACTIC CENTER, P.C.

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 1003073503 NPI number — MCKERNAN FAMILY CHIROPRACTIC CENTER, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCKERNAN FAMILY CHIROPRACTIC CENTER, P.C.
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:
1003073503
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
51863 SCHOENHERR RD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
SHELBY TWP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48315-2757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-997-4086
Provider Business Mailing Address Fax Number:
586-997-6916

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
51863 SCHOENHERR RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SHELBY TWP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48315-2757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-997-4086
Provider Business Practice Location Address Fax Number:
586-997-6916
Provider Enumeration Date:
05/21/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCKERNAN
Authorized Official First Name:
CHAD
Authorized Official Middle Name:
DONALD
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
586-997-4086

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2301008433 , 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)

  • Identifier: 950E05407 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4685500 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: CM008433 . This is a "COMMERCIAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".