Provider Demographics
NPI:1427186048
Name:KVBDCPC
Entity Type:Organization
Organization Name:KVBDCPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:V
Authorized Official - Last Name:BURBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-875-7340
Mailing Address - Street 1:350 1ST AVE E
Mailing Address - Street 2:
Mailing Address - City:DYERSVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52040-1203
Mailing Address - Country:US
Mailing Address - Phone:563-875-7340
Mailing Address - Fax:563-875-2713
Practice Address - Street 1:350 1ST AVE E
Practice Address - Street 2:
Practice Address - City:DYERSVILLE
Practice Address - State:IA
Practice Address - Zip Code:52040-1203
Practice Address - Country:US
Practice Address - Phone:563-875-7340
Practice Address - Fax:563-875-2713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAAO5240111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA72000Medicare ID - Type UnspecifiedGROUP #