Provider Demographics
NPI:1790904670
Name:KURTZ, GINA R (DC)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:R
Last Name:KURTZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:GINA
Other - Middle Name:R
Other - Last Name:DUVICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:7620 N UNIVERSITY ST STE 109
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-8300
Mailing Address - Country:US
Mailing Address - Phone:309-693-9600
Mailing Address - Fax:309-693-3616
Practice Address - Street 1:7620 N UNIVERSITY ST STE 109
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-8300
Practice Address - Country:US
Practice Address - Phone:309-693-9600
Practice Address - Fax:309-693-3616
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007993111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor