Provider Demographics
NPI:1689835662
Name:ANDERSON, KURT (DC)
Entity type:Individual
Prefix:DR
First Name:KURT
Middle Name:
Last Name:ANDERSON
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 1:13112 MOONFLOWER CT
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-7107
Mailing Address - Country:US
Mailing Address - Phone:239-645-4898
Mailing Address - Fax:786-472-6919
Practice Address - Street 1:13112 MOONFLOWER CT
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-7107
Practice Address - Country:US
Practice Address - Phone:239-645-4898
Practice Address - Fax:786-472-6919
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8462111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor