1497995310 NPI number — MCKERNAN FAMILY CHIROPRACTIC CENTER P.C.

Table of content: (NPI 1497995310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497995310 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:
1497995310
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50544 SCHOENHERR RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHELBY TWP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48315-3134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-532-1448
Provider Business Mailing Address Fax Number:
586-532-1472

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50544 SCHOENHERR RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELBY TWP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48315-3134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-532-1448
Provider Business Practice Location Address Fax Number:
586-532-1472
Provider Enumeration Date:
03/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MCKERNAN
Authorized Official First Name:
CHAD
Authorized Official Middle Name:
DONALD
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
586-532-1448

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: 16350 . This is a "M CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P31349 F . This is a "BLUE CARE NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 950E05407 . This is a "BLUE CROSS BLUE SHEILD" 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: 485778 . This is a "UMP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: CM008433 . This is a "FIRST HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: KERNAN . This is a "HAP" identifier . This identifiers is of the category "OTHER".




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