Provider Demographics
NPI:1497857478
Name:DOHERTY, KURT D (DC)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:D
Last Name:DOHERTY
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 1:22 ARTHUR WOODS AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-2517
Mailing Address - Country:US
Mailing Address - Phone:781-229-5705
Mailing Address - Fax:
Practice Address - Street 1:35 MAIN ST
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-2305
Practice Address - Country:US
Practice Address - Phone:781-233-1946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1618111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA043126502OtherTAX IDENTIFICATION
MA043126502OtherTAX IDENTIFICATION
MADOY36133Medicare ID - Type Unspecified