Provider Demographics
NPI:1609827609
Name:KURA, JACEK (MSPT, DC)
Entity Type:Individual
Prefix:DR
First Name:JACEK
Middle Name:
Last Name:KURA
Suffix:
Gender:M
Credentials:MSPT, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:553 WINTERTON RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12721-4119
Mailing Address - Country:US
Mailing Address - Phone:845-733-1470
Mailing Address - Fax:
Practice Address - Street 1:80 SULLIVAN ST
Practice Address - Street 2:
Practice Address - City:WURTSBORO
Practice Address - State:NY
Practice Address - Zip Code:12790-8226
Practice Address - Country:US
Practice Address - Phone:845-733-5022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-14
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011210-1111N00000X
NY026901-1225100000X
NY003371-1171100000X
NYX011210-2111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
No111NR0400XChiropractic ProvidersChiropractorRehabilitation