Provider Demographics
NPI:1861585416
Name:GUTKNECHT, KURT M
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:M
Last Name:GUTKNECHT
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 1:75 VERMILLION DR
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19054-1227
Mailing Address - Country:US
Mailing Address - Phone:267-261-1453
Mailing Address - Fax:
Practice Address - Street 1:75 VERMILLION DR
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19054-1227
Practice Address - Country:US
Practice Address - Phone:215-949-2292
Practice Address - Fax:215-945-5692
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAD.C. 002928-L111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0023216000OtherBLUE CROSS/SHIELD
PAD.C.-002928-LOtherSTATE LICENSE
PAGU25943Medicare ID - Type UnspecifiedCHIROPRACTIC
PA6485660001Medicare NSC