Provider Demographics
NPI:1578563656
Name:MIRTSCHING, DEWAYNE MARK (DC)
Entity Type:Individual
Prefix:MR
First Name:DEWAYNE
Middle Name:MARK
Last Name:MIRTSCHING
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 96
Mailing Address - Street 2:
Mailing Address - City:WALBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78673-0096
Mailing Address - Country:US
Mailing Address - Phone:512-864-1600
Mailing Address - Fax:
Practice Address - Street 1:3780 FM 972
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-1501
Practice Address - Country:US
Practice Address - Phone:512-864-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4020111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
4124531OtherAETNA
TXC06014297Medicaid
601429OtherBCBS
4124531OtherAETNA
T14854Medicare UPIN