Provider Demographics
NPI:1326156498
Name:WIRT, NATHANIEL SELVYN (PHD DC)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:SELVYN
Last Name:WIRT
Suffix:
Gender:M
Credentials:PHD DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:2600 NASA RD I SUITE 101
Mailing Address - City:SEABROOK
Mailing Address - State:TX
Mailing Address - Zip Code:77586
Mailing Address - Country:US
Mailing Address - Phone:281-532-9466
Mailing Address - Fax:281-532-9466
Practice Address - Street 1:2600 NASA RD I
Practice Address - Street 2:SUITE 101
Practice Address - City:SEABROOK
Practice Address - State:TX
Practice Address - Zip Code:77586
Practice Address - Country:US
Practice Address - Phone:281-532-9466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2909111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
601148Medicare ID - Type Unspecified