Provider Demographics
NPI:1528563392
Name:WYTRWAL, SETH ADAM (DC)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:ADAM
Last Name:WYTRWAL
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:PO BOX 18
Mailing Address - Street 2:
Mailing Address - City:SOUTH BARRE
Mailing Address - State:MA
Mailing Address - Zip Code:01074-0018
Mailing Address - Country:US
Mailing Address - Phone:303-517-5606
Mailing Address - Fax:
Practice Address - Street 1:31 LAKE ST STE 151
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440
Practice Address - Country:US
Practice Address - Phone:978-632-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3603111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor