Healthcare Provider Details

I. General information

NPI: 1578727004
Provider Name (Legal Business Name): JOHN WILLIAM KURPA DC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4261 LAFAYETTE ST
MARIANNA FL
32446-8235
US

IV. Provider business mailing address

6664 OLD SPANISH TRL
GRAND RIDGE FL
32442-3952
US

V. Phone/Fax

Practice location:
  • Phone: 850-482-3696
  • Fax:
Mailing address:
  • Phone: 850-592-9126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberCH0003672
License Number StateFL

VIII. Authorized Official

Name: DR. JOHN WILLIAM KURPA
Title or Position: OWNER
Credential: D.C., P.A.
Phone: 850-482-3696