Provider Demographics
NPI:1295892594
Name:ROSS, KURT L (DC)
Entity type:Individual
Prefix:DR
First Name:KURT
Middle Name:L
Last Name:ROSS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3015 CASA RIO CT
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33418-6508
Mailing Address - Country:US
Mailing Address - Phone:561-776-7270
Mailing Address - Fax:561-776-1960
Practice Address - Street 1:9121 N MILITARY TRL
Practice Address - Street 2:SUITE 104
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-5984
Practice Address - Country:US
Practice Address - Phone:561-776-7270
Practice Address - Fax:561-776-1960
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8356111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL76960Medicare ID - Type Unspecified