Healthcare Provider Details

I. General information

NPI: 1306872247
Provider Name (Legal Business Name): RONALD V KERN D. C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 CORNELIA ST
BOONTON NJ
07005-1709
US

IV. Provider business mailing address

117 CORNELIA ST
BOONTON NJ
07005-1709
US

V. Phone/Fax

Practice location:
  • Phone: 973-335-5400
  • Fax: 973-335-9194
Mailing address:
  • Phone: 973-335-5400
  • Fax: 973-335-9194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberMCO2777
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: