Healthcare Provider Details

I. General information

NPI: 1700845039
Provider Name (Legal Business Name): BRIAN WAYNE WENTZ D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 N DEPOT ST
LEBANON KY
40033-1422
US

IV. Provider business mailing address

308 N DEPOT ST
LEBANON KY
40033-1422
US

V. Phone/Fax

Practice location:
  • Phone: 270-692-2652
  • Fax: 270-692-6099
Mailing address:
  • Phone: 270-692-2652
  • Fax: 270-692-6099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4747
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: