Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 005042 | MO |
NPI | 1346287257 |
---|---|
Provider Name | Dr. Gary A. Kurtz |
First Address | Nevada, MO 64772-1110 |
Second Address | Nevada, MO 64772-1110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T73849 | (02) |