Healthcare Provider Details

I. General information

NPI: 1740363720
Provider Name (Legal Business Name): DORIS MARIE KUTZ-COMPTON D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 FRANKLIN AVE
NEW HAVEN MO
63068-1426
US

IV. Provider business mailing address

105 FRANKLIN AVE
NEW HAVEN MO
63068-1426
US

V. Phone/Fax

Practice location:
  • Phone: 573-237-7800
  • Fax:
Mailing address:
  • Phone: 573-237-7800
  • Fax: 573-237-4800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number006626
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: