Provider Demographics
NPI:1902986185
Name:KERENSKY-WILLE, DAWN MANETTE (DC)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:MANETTE
Last Name:KERENSKY-WILLE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PINE TREE LN
Mailing Address - Street 2:
Mailing Address - City:JOBSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08041-2028
Mailing Address - Country:US
Mailing Address - Phone:609-265-7727
Mailing Address - Fax:609-265-7079
Practice Address - Street 1:1 PINE TREE LN
Practice Address - Street 2:
Practice Address - City:JOBSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08041-2028
Practice Address - Country:US
Practice Address - Phone:609-265-7727
Practice Address - Fax:609-265-7079
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC04888111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
63311Medicare UPIN
050713Medicare ID - Type UnspecifiedDAWN KERENSKY-WILLE
080873Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER