Provider Demographics
NPI:1790245025
Name:RODNEY P WIRTH,DC PA
Entity Type:Organization
Organization Name:RODNEY P WIRTH,DC PA
Other - Org Name:STANCE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WYKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-708-3454
Mailing Address - Street 1:2401 AVENUE J STE 210
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-6118
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2401 AVENUE J STE 210
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-6118
Practice Address - Country:US
Practice Address - Phone:972-262-7373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RODNEY P WIRTH,DC PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-22
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8086OtherSTATE LICENSE