Provider Demographics
NPI:1083825434
Name:WEBB, KURT KRISTOPHER (DC)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:KRISTOPHER
Last Name:WEBB
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 1:15520 ROCKFIELD BLVD A200
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-6705
Mailing Address - Country:US
Mailing Address - Phone:949-598-9999
Mailing Address - Fax:949-598-9990
Practice Address - Street 1:671 1ST ST
Practice Address - Street 2:SUITE B
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-1803
Practice Address - Country:US
Practice Address - Phone:916-434-0600
Practice Address - Fax:916-434-0603
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0025563111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0255330OtherPTAN
CADC0255330OtherBLUE SHIELD
CADC25533OtherCHIROPRACTIC LICENSE