Provider Demographics
NPI:1801954235
Name:WURST, MATT R (DC)
Entity type:Individual
Prefix:DR
First Name:MATT
Middle Name:R
Last Name:WURST
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29465-0036
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:LEASANT
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC2276111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor