Provider Demographics
NPI:1306872247
Name:KERN, RONALD V (D C)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:V
Last Name:KERN
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 CORNELIA ST
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-1709
Mailing Address - Country:US
Mailing Address - Phone:973-335-5400
Mailing Address - Fax:973-335-9194
Practice Address - Street 1:117 CORNELIA ST
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-1709
Practice Address - Country:US
Practice Address - Phone:973-335-5400
Practice Address - Fax:973-335-9194
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMCO2777111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00787233OtherMEDICARE PTAN
NJ3370003Medicaid
NJP00787233OtherMEDICARE PTAN