Provider Demographics
NPI:1194820746
Name:WURST, KATHERINE A (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:A
Last Name:WURST
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 1:152 ROSWELL ST SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1945
Mailing Address - Country:US
Mailing Address - Phone:770-424-6222
Mailing Address - Fax:770-424-6789
Practice Address - Street 1:152 ROSWELL ST SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1945
Practice Address - Country:US
Practice Address - Phone:770-424-6222
Practice Address - Fax:770-424-6789
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2670111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA27-1211109OtherEIN #