MEDICARE: KURTZ CHIROPRACTIC OFFICE, LLC

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	5042	MO

General Provider Information

NPI Number	:	1861612178
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KURTZ CHIROPRACTIC OFFICE, LLC

Provider Business Mailing Address
First Line	:	1804 N ASH ST
Second Line	:	PO BOX 412
City	:	NEVADA
State	:	MO
Zip	:	64772-1110
Country	:	US
Telephone Number	:	417-667-3456
Fax Number	:	417-667-4654

Provider Business Practice Location Address
First Line	:	1804 N ASH ST
Second Line	:	BOX 412
City	:	NEVADA
State	:	MO
Zip	:	64772-1110
Country	:	US
Telephone Number	:	417-667-3456
Fax Number	:	417-667-4654

Authorized Official
Title or Position	:	OWNER MANAGER
Name	:	DR. GARY A KURTZ
Credential	:	DC
Telephone Number	:	417-667-3456

Provider Enumeration Date	:	04/27/2007
Last Update Date	:	08/22/2020

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