Provider Demographics
NPI:1982825105
Name:WENZEL, IRA (DC)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:
Last Name:WENZEL
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 1:1560 SW 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-7002
Mailing Address - Country:US
Mailing Address - Phone:561-955-9400
Mailing Address - Fax:561-955-1988
Practice Address - Street 1:501 E CAMINO REAL STE 173
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-6127
Practice Address - Country:US
Practice Address - Phone:561-955-9400
Practice Address - Fax:561-955-1988
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 7189111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
55531AMedicare ID - Type Unspecified
U69738Medicare UPIN