Provider Demographics
NPI:1508366246
Name:VIRGIN, KURT THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:THOMAS
Last Name:VIRGIN
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 1:11035 LONGBOAT KEY LN APT 309
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-2754
Mailing Address - Country:US
Mailing Address - Phone:217-313-0744
Mailing Address - Fax:
Practice Address - Street 1:4040 TAMPA RD
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-3205
Practice Address - Country:US
Practice Address - Phone:813-818-7499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12394111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor