Provider Demographics
NPI:1376507970
Name:SHULL, KURT A (DC)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:A
Last Name:SHULL
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 1:1025 S COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-2236
Mailing Address - Country:US
Mailing Address - Phone:931-967-4232
Mailing Address - Fax:931-962-1988
Practice Address - Street 1:1025 S COLLEGE ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2236
Practice Address - Country:US
Practice Address - Phone:931-967-4232
Practice Address - Fax:931-962-1988
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0823111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3676275Medicaid
TNU30339Medicare UPIN
TN3676275Medicaid