Provider Demographics
NPI:1366749061
Name:HALVERSON, KURT (DC)
Entity type:Individual
Prefix:DR
First Name:KURT
Middle Name:
Last Name:HALVERSON
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 1:400 HUALANI ST
Mailing Address - Street 2:SUITE 191
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4378
Mailing Address - Country:US
Mailing Address - Phone:808-961-6373
Mailing Address - Fax:808-961-9133
Practice Address - Street 1:400 HUALANI ST
Practice Address - Street 2:SUITE 191
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4378
Practice Address - Country:US
Practice Address - Phone:808-961-6373
Practice Address - Fax:808-961-9133
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI293111N00000X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
No111N00000XChiropractic ProvidersChiropractor