Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 038009791 | IL |
N | 111NI0900X | Internist | 038009791 | IL |
N | 111NN1001X | Nutrition | 038009791 | IL |
N | 111NR0400X | Rehabilitation Chiropractor | 038009791 | IL |
Y | 111NS0005X | Chiropractic Sports Physician | 038009791 | IL |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 038009791 | IL |
NPI | 1366591059 |
---|---|
Provider Name | Dr. Jeffrey Kurtz |
First Address | Richland, MI 49083-8629 |
Second Address | Richland, MI 49083-8500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 16/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01632888 | BCBS PROVIDER ID (01) | IL |