Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | CE005650 | MO |
NPI | 1134213044 |
---|---|
Provider Name | Dr. John Edward Kiernan JR. |
First Address | Swansea, IL 62226-8908 |
Second Address | Saint Louis, MO 63104-4305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |