Healthcare Provider Details

I. General information

NPI: 1376635912
Provider Name (Legal Business Name): KURT JOHN OLDING D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 09/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12A EAGLE DR
MINSTER OH
45865-9714
US

IV. Provider business mailing address

12A EAGLE DR
MINSTER OH
45865-9714
US

V. Phone/Fax

Practice location:
  • Phone: 419-628-3004
  • Fax: 419-628-3506
Mailing address:
  • Phone: 419-628-3004
  • Fax: 419-628-3506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1062
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: