MEDICARE: KERN CHIROPRACTIC PLLC

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

General Provider Information

NPI Number	:	1912659590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KERN CHIROPRACTIC PLLC

Provider Business Mailing Address
First Line	:	14457 HENDRICKS AVE
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48089-2864
Country	:	US
Telephone Number	:	810-278-0647
Fax Number	:

Provider Business Practice Location Address
First Line	:	37300 DEQUINDRE RD STE 112
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-3597
Country	:	US
Telephone Number	:	586-978-8240
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JACOB KERN
Credential	:	DC
Telephone Number	:	810-278-0647

Provider Enumeration Date	:	01/25/2022
Last Update Date	:	01/25/2022

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