Provider Demographics
NPI:1679111207
Name:HURT, JOHN K (L AC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:K
Last Name:HURT
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15719 DREXEL CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-2359
Mailing Address - Country:US
Mailing Address - Phone:402-672-7376
Mailing Address - Fax:
Practice Address - Street 1:1000 N 72ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3245
Practice Address - Country:US
Practice Address - Phone:402-827-1355
Practice Address - Fax:402-827-1357
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE70171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist