Healthcare Provider Details

I. General information

NPI: 1982730198
Provider Name (Legal Business Name): JOHN WILLIAM KURPA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2007
Last Update Date: 08/19/2008
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:
Title or Position:
Credential:
Phone: