Healthcare Provider Details

I. General information

NPI: 1194820746
Provider Name (Legal Business Name): KATHERINE A WURST DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 02/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 ROSWELL ST SE
MARIETTA GA
30060-1945
US

IV. Provider business mailing address

152 ROSWELL ST SE
MARIETTA GA
30060-1945
US

V. Phone/Fax

Practice location:
  • Phone: 770-424-6222
  • Fax: 770-424-6789
Mailing address:
  • Phone: 770-424-6222
  • Fax: 770-424-6789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2670
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: