Healthcare Provider Details

I. General information

NPI: 1366591059
Provider Name (Legal Business Name): JEFFREY KURTZ DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8152 N 32ND ST STE C
RICHLAND MI
49083-8500
US

IV. Provider business mailing address

8547 GULL RD
RICHLAND MI
49083-8629
US

V. Phone/Fax

Practice location:
  • Phone: 269-267-8459
  • Fax:
Mailing address:
  • Phone: 269-267-8459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number038009791
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number038009791
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number038009791
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number038009791
License Number StateIL
# 5
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number038009791
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: