MEDICARE: DR. KURT WILLIAM EDEKER DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NR0400X	Rehabilitation Chiropractor	09962	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	09962	OTHER	TX	CHIROPRACTIC LICENSE

General Provider Information

NPI Number	:	1003096975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KURT WILLIAM EDEKER DC

Provider Business Mailing Address
First Line	:	PO BOX 700688
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78270-0688
Country	:	US
Telephone Number	:	800-404-6050
Fax Number	:	866-313-3397

Provider Business Practice Location Address
First Line	:	9001 BRODIE LN STE C5
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-5005
Country	:	US
Telephone Number	:	800-404-6050
Fax Number	:	866-313-3397

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2007
Last Update Date	:	02/22/2024

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