Provider Demographics
NPI:1205896412
Name:WURST, BRIAN EDWARD (DC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:EDWARD
Last Name:WURST
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 1:1232 BRANSON HILLS PKWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-9943
Mailing Address - Country:US
Mailing Address - Phone:417-338-9355
Mailing Address - Fax:417-708-9797
Practice Address - Street 1:1232 BRANSON HILLS PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-9943
Practice Address - Country:US
Practice Address - Phone:417-338-9355
Practice Address - Fax:417-708-9797
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4943111N00000X
MO2002030435111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0930480OtherBLUECROSS BLUESHIELD AZ
AZ35WCGJH04OtherAZ. STATE COMP.
AZ35WCGJH04OtherAZ. STATE COMP.
AZU37975Medicare UPIN
AZAZ0930480OtherBLUECROSS BLUESHIELD AZ