Provider Demographics
NPI:1053480798
Name:GRIESSER, KURT WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:WILLIAM
Last Name:GRIESSER
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 1:5401 AVE I
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471
Mailing Address - Country:US
Mailing Address - Phone:281-342-5337
Mailing Address - Fax:281-342-5337
Practice Address - Street 1:5401 AVE I
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471
Practice Address - Country:US
Practice Address - Phone:281-342-5337
Practice Address - Fax:281-342-5337
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3051111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2306013186Medicaid
601318Medicare UPIN
TX2306013186Medicaid