Provider Demographics
NPI:1720429186
Name:KURTH, ALYSSA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:MARIE
Last Name:KURTH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 TOUCHSTONE APT 64
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-1959
Mailing Address - Country:US
Mailing Address - Phone:971-777-0237
Mailing Address - Fax:
Practice Address - Street 1:30485 SW BOONES FERRY RD STE 104
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-7845
Practice Address - Country:US
Practice Address - Phone:515-965-8280
Practice Address - Fax:515-965-5965
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5550111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor