Provider Demographics
NPI:1902010200
Name:WENTWORTH, WILLIAM ALLEN JR (DC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ALLEN
Last Name:WENTWORTH
Suffix:JR
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 1:225 HALTON ROAD SUITE A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607
Mailing Address - Country:US
Mailing Address - Phone:864-286-0660
Mailing Address - Fax:864-286-0616
Practice Address - Street 1:225 HALTON ROAD SUITE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607
Practice Address - Country:US
Practice Address - Phone:864-286-0660
Practice Address - Fax:864-286-0616
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2218111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2218OtherSTATE SC LICENSE
SC25820OtherCALIFORNIA LICENSE
FLCH7257OtherFLORIDA LICENSE
FLCH7257OtherFLORIDA LICENSE