Provider Demographics
NPI:1982730198
Name:KURPA, JOHN WILLIAM
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WILLIAM
Last Name:KURPA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6664 OLD SPANISH TRL
Mailing Address - Street 2:
Mailing Address - City:GRAND RIDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32442-3952
Mailing Address - Country:US
Mailing Address - Phone:850-592-9126
Mailing Address - Fax:
Practice Address - Street 1:4261 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-8235
Practice Address - Country:US
Practice Address - Phone:850-482-3696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-24
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0003672111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88670OtherBLUE CROSS/ BLUE SHIELD
FLCHOOO3672OtherCHIROPRACTIC LICENSE
FL88670OtherBLUE CROSS/ BLUE SHIELD