Provider Demographics
NPI:1932783263
Name:WORTHMANN, KURT MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:KURT
Middle Name:MICHAEL
Last Name:WORTHMANN
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 1:19924 JETTON RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-8253
Mailing Address - Country:US
Mailing Address - Phone:704-896-8446
Mailing Address - Fax:704-896-8495
Practice Address - Street 1:19924 JETTON RD STE 101
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-8253
Practice Address - Country:US
Practice Address - Phone:704-896-8446
Practice Address - Fax:704-896-8495
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5319111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5319OtherNORTH CAROLINA CHIROPRACTIC LICENSE