Provider Demographics
NPI:1609070309
Name:FROESE, KURT DOUGLAS (CHIROPRACTIC)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:DOUGLAS
Last Name:FROESE
Suffix:
Gender:M
Credentials:CHIROPRACTIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-2938
Mailing Address - Country:US
Mailing Address - Phone:231-933-1117
Mailing Address - Fax:
Practice Address - Street 1:1203 E 8TH ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-2938
Practice Address - Country:US
Practice Address - Phone:231-933-1117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP47460002Medicare PIN