Provider Demographics
NPI:1720291420
Name:WURTZ, JASON TROY (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:TROY
Last Name:WURTZ
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 1:302 W MEADOW ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SMITHVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64089-9362
Mailing Address - Country:US
Mailing Address - Phone:816-532-4774
Mailing Address - Fax:856-344-1360
Practice Address - Street 1:302 W MEADOW ST
Practice Address - Street 2:SUITE A
Practice Address - City:SMITHVILLE
Practice Address - State:MO
Practice Address - Zip Code:64089-9362
Practice Address - Country:US
Practice Address - Phone:816-532-4774
Practice Address - Fax:856-344-1360
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001013757111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOQ53C936Medicare PIN