Provider Demographics
NPI:1831118546
Name:SCHICHTL, KURT RANDALL (DC)
Entity type:Individual
Prefix:DR
First Name:KURT
Middle Name:RANDALL
Last Name:SCHICHTL
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 1:1301 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:EMMAUS
Mailing Address - State:PA
Mailing Address - Zip Code:18049-1920
Mailing Address - Country:US
Mailing Address - Phone:610-967-4996
Mailing Address - Fax:610-967-0110
Practice Address - Street 1:1301 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:EMMAUS
Practice Address - State:PA
Practice Address - Zip Code:18049-1920
Practice Address - Country:US
Practice Address - Phone:610-967-4996
Practice Address - Fax:610-967-0110
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005021L111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA090199Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID