Healthcare Provider Details

I. General information

NPI: 1811525025
Provider Name (Legal Business Name): KURT THOMAS URBIN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 05/27/2022
Certification Date: 05/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17949 HALL RD
MACOMB MI
48044-4557
US

IV. Provider business mailing address

17949 HALL RD
MACOMB MI
48044-4557
US

V. Phone/Fax

Practice location:
  • Phone: 586-738-6088
  • Fax: 586-620-6511
Mailing address:
  • Phone: 586-738-6088
  • Fax: 586-620-6511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301010930
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: