Healthcare Provider Details

I. General information

NPI: 1184179921
Provider Name (Legal Business Name): KURT HOVERSON D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8354 SANTA MONICA BLVD
WEST HOLLYWOOD CA
90069-4313
US

IV. Provider business mailing address

8354 SANTA MONICA BLVD
WEST HOLLYWOOD CA
90069-4313
US

V. Phone/Fax

Practice location:
  • Phone: 323-831-2455
  • Fax:
Mailing address:
  • Phone: 323-831-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number33659
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: