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General NPI Number Information
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NPI Number | 1598712267
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Entity Type | Organization
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Legal Business Name | DEANDA CHIROPRACTIC CLINIC LLC
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Dates
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Enumeration Date | 05/28/2006
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Last Update Date | 02/18/2009
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Provider Practice Location Address
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Address Line | 2887 KRAFFT RD SUITE 1400
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City | PORT HURON
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State | MI
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Zip | 48060
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Country | US
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Telephone | 810-984-1994
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Fax | 810-984-3266
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Provider Business Mailing Address
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Address Line | 2887 KRAFFT RD SUITE 1400
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City | PORT HURON
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State | MI
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Zip | 48060
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Country | US
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Telephone | 810-984-1994
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Fax | 810-984-3266
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Authorized Official
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Title or Position | OWNER
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Name | MR. STEVEN ANTHONY KERN
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Credential | DC
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Telephone | 810-765-9700
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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 | 2301005582
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License Number State | MI
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