Provider Demographics
NPI:1144657495
Name:KURTZ, SHANNON RAE (DC)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:RAE
Last Name:KURTZ
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:W164N11297 SQUIRE DR
Mailing Address - Street 2:STE E
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-6028
Mailing Address - Country:US
Mailing Address - Phone:262-250-1948
Mailing Address - Fax:
Practice Address - Street 1:7000 S 76TH ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-9077
Practice Address - Country:US
Practice Address - Phone:414-525-9500
Practice Address - Fax:414-525-0900
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4943-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor