Provider Demographics
NPI:1467636324
Name:WORTMAN, JON SETH (DC)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:SETH
Last Name:WORTMAN
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 1:1685 MARKET PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7936
Mailing Address - Country:US
Mailing Address - Phone:770-889-3445
Mailing Address - Fax:770-889-2212
Practice Address - Street 1:1685 MARKET PLACE BLVD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7936
Practice Address - Country:US
Practice Address - Phone:770-889-3445
Practice Address - Fax:770-889-2212
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA04723111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU90830Medicare UPIN
GA35ZCBTZMedicare PIN