Provider Demographics
NPI:1699081760
Name:BAHNEMANN, KERRI MICHELLE (DC)
Entity type:Individual
Prefix:DR
First Name:KERRI
Middle Name:MICHELLE
Last Name:BAHNEMANN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:KERRI
Other - Middle Name:MICHELLE
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5421 HOPALONG TRL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-4603
Mailing Address - Country:US
Mailing Address - Phone:719-258-8389
Mailing Address - Fax:877-816-1718
Practice Address - Street 1:7610 N UNION BLVD STE 125
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3806
Practice Address - Country:US
Practice Address - Phone:719-258-8389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556365111N00000X
MT839111N00000X
CO6355111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000162588Medicaid
MT000162588Medicaid