Provider Demographics
NPI:1679593438
Name:OETJENS, KURT AARON (DC)
Entity type:Individual
Prefix:DR
First Name:KURT
Middle Name:AARON
Last Name:OETJENS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7947 ANTES DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-9145
Mailing Address - Country:US
Mailing Address - Phone:734-587-6362
Mailing Address - Fax:
Practice Address - Street 1:303 STEWART ROAD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-3232
Practice Address - Country:US
Practice Address - Phone:734-243-5411
Practice Address - Fax:734-243-5517
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI562737111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM86670Medicare UPIN