Provider Demographics
NPI:1679610687
Name:KENNETH STERN CHIROPRACTIC
Entity type:Organization
Organization Name:KENNETH STERN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:216-476-1300
Mailing Address - Street 1:13550 LORAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-3434
Mailing Address - Country:US
Mailing Address - Phone:216-671-5177
Mailing Address - Fax:
Practice Address - Street 1:13550 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-3434
Practice Address - Country:US
Practice Address - Phone:216-671-5177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC1864111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty