Provider Demographics
NPI:1740363720
Name:KUTZ-COMPTON, DORIS MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:DORIS
Middle Name:MARIE
Last Name:KUTZ-COMPTON
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 1:105 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:MO
Mailing Address - Zip Code:63068-1426
Mailing Address - Country:US
Mailing Address - Phone:573-237-7800
Mailing Address - Fax:573-237-4800
Practice Address - Street 1:105 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:MO
Practice Address - Zip Code:63068-1426
Practice Address - Country:US
Practice Address - Phone:573-237-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006626111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO118500OtherBLUE CROSS BLUE SHIELD
MO384104OtherHEALTHLINK
MO4401300OtherUNITED HEALTHCARE
MO4401300OtherUNITED HEALTHCARE