MEDICARE: KENNETH C. STURGIS DC SC

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	111N00000X	Chiropractor	1759	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124151956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENNETH C. STURGIS DC SC

Provider Business Mailing Address
First Line	:	2420 FINGER RD
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54302-4210
Country	:	US
Telephone Number	:	920-465-6040
Fax Number	:	920-465-4464

Provider Business Practice Location Address
First Line	:	2420 FINGER RD
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54302-4210
Country	:	US
Telephone Number	:	920-465-6040
Fax Number	:	920-465-4464

Authorized Official
Title or Position	:	OWNER
Name	:	KENNETH C. STURGIS
Credential	:
Telephone Number	:	920-465-6040

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	08/29/2007

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