MEDICARE: KEVIN RALPH CARON D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2301010029	MI

General Provider Information

NPI Number	:	1336492594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN RALPH CARON D.C.

Provider Business Mailing Address
First Line	:	27322 23 MILE RD
Second Line	:	SUITE 3
City	:	CHESTERFIELD
State	:	MI
Zip	:	48051-2032
Country	:	US
Telephone Number	:	586-598-9120
Fax Number	:

Provider Business Practice Location Address
First Line	:	27322 23 MILE RD
Second Line	:	SUITE 3
City	:	CHESTERFIELD
State	:	MI
Zip	:	48051-2032
Country	:	US
Telephone Number	:	586-598-9120
Fax Number	:	586-598-9155

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2012
Last Update Date	:	10/24/2012

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