Provider Demographics
NPI:1598315327
Name:WURTH, ZACHARY (DC)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:WURTH
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 1:3940 W CALLA RD
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9119
Mailing Address - Country:US
Mailing Address - Phone:712-541-2007
Mailing Address - Fax:
Practice Address - Street 1:3940 W CALLA RD
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9119
Practice Address - Country:US
Practice Address - Phone:712-541-2007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHINT-00058111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor