Provider Demographics
NPI:1962622175
Name:MCKERNAN, CHAD DONALD (DC)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:DONALD
Last Name:MCKERNAN
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 1:50544 SCHOENHERR RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-3134
Mailing Address - Country:US
Mailing Address - Phone:586-532-1448
Mailing Address - Fax:586-532-1472
Practice Address - Street 1:50544 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48315-3134
Practice Address - Country:US
Practice Address - Phone:586-532-1448
Practice Address - Fax:586-532-1472
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008433111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2154482OtherFIRST HEALTH
MICM008433OtherCOMMERCIAL
MIP31349FOtherBLUE CARE NETWORK
MI16350OtherM CARE
MI4685500Medicaid
MI950E05407OtherBLUE CROSS BLUE SHIELD
MI4685500Medicaid
MI1962622175Medicare NSC
MION65710Medicare PIN