Provider Demographics
NPI:1417044140
Name:KURZ, THEODORE EARL (CHIROPRACTIC PHYSICI)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:EARL
Last Name:KURZ
Suffix:
Gender:M
Credentials:CHIROPRACTIC PHYSICI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1803
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70004-1803
Mailing Address - Country:US
Mailing Address - Phone:504-838-8330
Mailing Address - Fax:985-796-1819
Practice Address - Street 1:3821 TRANSCONTINENTAL DR
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2639
Practice Address - Country:US
Practice Address - Phone:504-838-8330
Practice Address - Fax:985-796-1819
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA196111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA59017Medicare ID - Type Unspecified