Provider Demographics
NPI:1104979343
Name:MICHELLE A KERN DC PSC
Entity type:Organization
Organization Name:MICHELLE A KERN DC PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KERN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:859-277-7521
Mailing Address - Street 1:101 MALABU DR
Mailing Address - Street 2:SUITE 10
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3141
Mailing Address - Country:US
Mailing Address - Phone:859-277-7521
Mailing Address - Fax:859-275-2020
Practice Address - Street 1:101 MALABU DR
Practice Address - Street 2:SUITE 10
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3141
Practice Address - Country:US
Practice Address - Phone:859-277-7521
Practice Address - Fax:859-275-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4476111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYU73490Medicare UPIN
KY6083201Medicare ID - Type Unspecified