=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063500460
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENNETH HOWARD STERN DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2006
-----------------------------------------------------
Last Update Date | 11/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13550 LORAIN AVE
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44111-3434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-431-4700
-----------------------------------------------------
Fax | 216-671-5177
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13550 LORAIN AVE
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44111-3434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-476-1300
-----------------------------------------------------
Fax | 216-476-1950
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC-01866
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------