Provider Demographics
NPI:1457464307
Name:KEPPNER, KURT JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:JAMES
Last Name:KEPPNER
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 1:218 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARE
Mailing Address - State:MI
Mailing Address - Zip Code:48617-1556
Mailing Address - Country:US
Mailing Address - Phone:989-424-6360
Mailing Address - Fax:989-424-6362
Practice Address - Street 1:218 E 5TH ST
Practice Address - Street 2:
Practice Address - City:CLARE
Practice Address - State:MI
Practice Address - Zip Code:48617-1556
Practice Address - Country:US
Practice Address - Phone:989-424-6360
Practice Address - Fax:989-424-6362
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006055111N00000X
MI2301009243111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI5547Medicare PIN