Healthcare Provider Details

I. General information

NPI: 1346287257
Provider Name (Legal Business Name): GARY A. KURTZ D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 N ASH ST
NEVADA MO
64772-1110
US

IV. Provider business mailing address

1804 N ASH ST PO BOX 412
NEVADA MO
64772-1110
US

V. Phone/Fax

Practice location:
  • Phone: 417-667-3456
  • Fax: 417-667-4654
Mailing address:
  • Phone: 417-667-3456
  • Fax: 417-667-4654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number005042
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: