Provider Demographics
NPI:1992851794
Name:KERN, GREGORY VIRGIL (DC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:VIRGIL
Last Name:KERN
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 1:708 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804-4105
Mailing Address - Country:US
Mailing Address - Phone:563-323-4310
Mailing Address - Fax:
Practice Address - Street 1:606 E 38TH ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-1604
Practice Address - Country:US
Practice Address - Phone:563-386-9119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05284111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA19834OtherPIN