Provider Demographics
NPI:1154450559
Name:KURTZ, ROBERT C (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
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 1:92 E STATE ROAD 59 STE C
Mailing Address - Street 2:
Mailing Address - City:EDGERTON
Mailing Address - State:WI
Mailing Address - Zip Code:53534-9142
Mailing Address - Country:US
Mailing Address - Phone:608-921-2440
Mailing Address - Fax:
Practice Address - Street 1:123 N HENRY ST
Practice Address - Street 2:
Practice Address - City:EDGERTON
Practice Address - State:WI
Practice Address - Zip Code:53534-1822
Practice Address - Country:US
Practice Address - Phone:608-884-8731
Practice Address - Fax:608-884-8731
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2017-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIT-62-516Medicare UPIN
WI75325Medicare ID - Type Unspecified