Justin Kersten, DC

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

CHIR010493 Issued in GA

Practice address

1834 S Cobb Industrial Blvd SE
Smyrna, GA 30082-4908

Phone

(404) 594-5809

NPI assigned

Aug 24, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• LPC Alpharetta LLC

  • Chiropractor
  • Alpharetta, GA
  • NPI 1033980222
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1629763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629763200000",
    "number": "1114694411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "942 MCLINDEN AVE SE",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300804142",
            "telephone_number": "586-744-2802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1834 S COBB INDUSTRIAL BLVD SE",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300824908",
            "telephone_number": "404-594-5809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KERSTEN",
        "first_name": "JUSTIN",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-08-24",
        "last_updated": "2021-08-24",
        "certification_date": "2021-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "GA",
            "license": "CHIR010493",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sports Physician Chiropractor in Smyrna, GA
• Providers in Smyrna, GA by specialty
• Sports Physician Chiropractor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.