Provider Demographics
NPI:1245506112
Name:HARRY J WURMSDOBLER, DC A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:HARRY J WURMSDOBLER, DC A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WURMSDOBLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:626-445-0326
Mailing Address - Street 1:131 E HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3212
Mailing Address - Country:US
Mailing Address - Phone:626-445-0326
Mailing Address - Fax:626-445-5155
Practice Address - Street 1:131 E HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3212
Practice Address - Country:US
Practice Address - Phone:626-445-0326
Practice Address - Fax:626-445-5155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-26
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20045261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU70250Medicare UPIN