Provider Demographics
NPI:1891872404
Name:KIERNAN, JAMES E (DC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:KIERNAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11506 BEACH CHANNEL DR
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-2206
Mailing Address - Country:US
Mailing Address - Phone:718-945-0406
Mailing Address - Fax:718-318-8179
Practice Address - Street 1:11506 BEACH CHANNEL DR
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2206
Practice Address - Country:US
Practice Address - Phone:718-945-0406
Practice Address - Fax:718-318-8179
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX003817-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCO 38176OtherWCB AUTH CODE
NY0060928OtherGHI PROVIDER ID #
NYP1614199OtherOXFORD PROVIDER ID
NY0060928OtherGHI PROVIDER ID #