Provider Demographics
NPI:1598752545
Name:REPP, KIRT W (DC)
Entity Type:Individual
Prefix:
First Name:KIRT
Middle Name:W
Last Name:REPP
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:PO BOX 9973
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77387-6973
Mailing Address - Country:US
Mailing Address - Phone:281-831-6290
Mailing Address - Fax:832-442-3800
Practice Address - Street 1:3033 HARTLEY RD STE 6
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-6280
Practice Address - Country:US
Practice Address - Phone:904-481-1111
Practice Address - Fax:832-442-3800
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1811111N00000X
FL12872111N00000X
TXTX8323111N00000X
FLCH12872111N00000X
TX8323111NR0200X, 111NX0100X, 111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
No111N00000XChiropractic ProvidersChiropractor
No111NR0200XChiropractic ProvidersChiropractorRadiology
No111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8P5801OtherBLUE CROSS BLUE SHIELD
TX8P5801OtherBLUE CROSS BLUE SHIELD
TXV02179Medicare UPIN