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General NPI Number Information
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NPI Number | 1144367210
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Entity Type | Organization
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Legal Business Name | KERSTEN CHIROPRACTIC PC
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 10/09/2007
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Provider Practice Location Address
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Address Line | 630 MAIN ST. A
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City | FREDERICK
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State | CO
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Zip | 80530
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Country | US
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Telephone | 303-833-1500
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Fax | 303-833-1813
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Provider Business Mailing Address
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Address Line | PO BOX 941
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City | FREDERICK
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State | CO
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Zip | 80530-0941
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Country | US
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Telephone | 303-833-1500
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Fax | 303-833-1813
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRAD RYAN KERSTEN
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Credential | D.C.
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Telephone | 303-833-1500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5030
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License Number State | CO
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