Provider Demographics
NPI:1184440661
Name:WIRTJES, HENRY
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:WIRTJES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 FRONT PLACE, APARTMENT 1201
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287
Mailing Address - Country:US
Mailing Address - Phone:320-760-0578
Mailing Address - Fax:
Practice Address - Street 1:1337 N SUMTER BLVD
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34286-8072
Practice Address - Country:US
Practice Address - Phone:877-442-4476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-29
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15266111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor