Provider Demographics
NPI:1710149109
Name:WRIGHT, KIRK THOMAS (DC, RN)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:THOMAS
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:DC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3601
Mailing Address - Country:US
Mailing Address - Phone:310-856-7999
Mailing Address - Fax:310-856-7771
Practice Address - Street 1:757 W 9TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3601
Practice Address - Country:US
Practice Address - Phone:310-856-7999
Practice Address - Fax:310-856-7771
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24671111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor