Provider Demographics
NPI:1255624136
Name:WURST CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:WURST CHIROPRACTIC CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:R
Authorized Official - Last Name:WURST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-884-3506
Mailing Address - Street 1:1350 CHUCK DAWLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3380
Mailing Address - Country:US
Mailing Address - Phone:843-884-3506
Mailing Address - Fax:843-856-0912
Practice Address - Street 1:1350 CHUCK DAWLEY BLVD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3380
Practice Address - Country:US
Practice Address - Phone:843-884-3506
Practice Address - Fax:843-856-0912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2276111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCU767900281OtherMEDICARE PTAN