Provider Demographics
NPI:1043242647
Name:KURTZ, ERIC R (DC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:R
Last Name:KURTZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 FOWLER ST
Mailing Address - Street 2:STE 1C
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4719
Mailing Address - Country:US
Mailing Address - Phone:509-582-3549
Mailing Address - Fax:509-586-4313
Practice Address - Street 1:1305 FOWLER ST STE 1C
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4719
Practice Address - Country:US
Practice Address - Phone:509-582-3549
Practice Address - Fax:509-586-4313
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH 2564111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2017457Medicaid
WAU25383Medicare UPIN
WA5760810001Medicare NSC