MEDICARE: KEVIN W KAURICH D.C.

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	08001607	IN

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
2	000000093017	OTHER	IN	ANTHEM

General Provider Information

NPI Number	:	1295768695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN W KAURICH D.C.

Provider Business Mailing Address
First Line	:	21421 CLEVELAND RD
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46628-3507
Country	:	US
Telephone Number	:	574-282-2828
Fax Number	:	574-282-1802

Provider Business Practice Location Address
First Line	:	21421 CLEVELAND RD
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46628-3507
Country	:	US
Telephone Number	:	574-282-2828
Fax Number	:	574-282-1802

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

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	07/15/2024

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