MEDICARE: KIRT W REPP 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	111N00000X	Chiropractor	1811	LA
2	111N00000X	Chiropractor	12872	FL
3	111N00000X	Chiropractor	TX8323	TX
4	111N00000X	Chiropractor	CH12872	FL
5	111NR0200X	Radiology Chiropractor	8323	TX
6	111NX0100X	Occupational Health Chiropractor	8323	TX
7	111NN0400X	Neurology Chiropractor	8323	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8P5801	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1598752545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRT W REPP DC

Provider Business Mailing Address
First Line	:	PO BOX 9973
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77387-6973
Country	:	US
Telephone Number	:	281-831-6290
Fax Number	:	832-442-3800

Provider Business Practice Location Address
First Line	:	3033 HARTLEY RD STE 6
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-6280
Country	:	US
Telephone Number	:	904-481-1111
Fax Number	:	832-442-3800

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	01/19/2023

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Directions to “ KIRT W REPP DC” Practice Location

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