Provider Demographics
NPI:1154340222
Name:KERN, JOHN P (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:KERN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:4550 BALFOUR ROAD, SUITE D
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-1582
Mailing Address - Country:US
Mailing Address - Phone:925-308-7575
Mailing Address - Fax:925-240-7878
Practice Address - Street 1:4550 BALFOUR ROAD, SUITE D
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-1582
Practice Address - Country:US
Practice Address - Phone:925-308-7575
Practice Address - Fax:925-240-7878
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC213880111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0213880Medicare PIN