Provider Demographics
NPI:1174681746
Name:KUKURIN CHIROPRACTIC GROUP
Entity Type:Organization
Organization Name:KUKURIN CHIROPRACTIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF STAFF
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:W
Authorized Official - Last Name:KUKURIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-687-5252
Mailing Address - Street 1:2415 SARAH ST
Mailing Address - Street 2:100
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-2228
Mailing Address - Country:US
Mailing Address - Phone:412-381-4453
Mailing Address - Fax:
Practice Address - Street 1:2415 SARAH ST
Practice Address - Street 2:100
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15203-2228
Practice Address - Country:US
Practice Address - Phone:412-381-4453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2746L111NN0400X
PA2888L111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
Not Answered111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0965855Medicaid
PA102355Medicare ID - Type UnspecifiedMEDICARE ID