Healthcare Provider Details

I. General information

NPI: 1144367210
Provider Name (Legal Business Name): KERSTEN CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 MAIN ST. A
FREDERICK CO
80530
US

IV. Provider business mailing address

PO BOX 941
FREDERICK CO
80530-0941
US

V. Phone/Fax

Practice location:
  • Phone: 303-833-1500
  • Fax: 303-833-1813
Mailing address:
  • Phone: 303-833-1500
  • Fax: 303-833-1813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5030
License Number StateCO

VIII. Authorized Official

Name: DR. BRAD RYAN KERSTEN
Title or Position: PRESIDENT
Credential: D.C.
Phone: 303-833-1500