Provider Demographics
NPI:1376635912
Name:OLDING, KURT JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:JOHN
Last Name:OLDING
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 1:12A EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:MINSTER
Mailing Address - State:OH
Mailing Address - Zip Code:45865-9714
Mailing Address - Country:US
Mailing Address - Phone:419-628-3004
Mailing Address - Fax:419-628-3506
Practice Address - Street 1:12A EAGLE DR
Practice Address - Street 2:
Practice Address - City:MINSTER
Practice Address - State:OH
Practice Address - Zip Code:45865-9714
Practice Address - Country:US
Practice Address - Phone:419-628-3004
Practice Address - Fax:419-628-3506
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1062111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT48136Medicare UPIN
OHOL0561372Medicare ID - Type Unspecified