Healthcare Provider Details

I. General information

NPI: 1427730241
Provider Name (Legal Business Name): ADAM WYATT KURZFELD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 PINE RIDGE RD
UKIAH CA
95482-3700
US

IV. Provider business mailing address

820 PINE RIDGE RD
UKIAH CA
95482-3700
US

V. Phone/Fax

Practice location:
  • Phone: 707-391-1022
  • Fax:
Mailing address:
  • Phone: 707-391-1022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: