Healthcare Provider Details

I. General information

NPI: 1720291420
Provider Name (Legal Business Name): JASON TROY WURTZ D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 W MEADOW ST SUITE A
SMITHVILLE MO
64089-9362
US

IV. Provider business mailing address

302 W MEADOW ST SUITE A
SMITHVILLE MO
64089-9362
US

V. Phone/Fax

Practice location:
  • Phone: 816-532-4774
  • Fax: 856-344-1360
Mailing address:
  • Phone: 816-532-4774
  • Fax: 856-344-1360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2001013757
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: