Healthcare Provider Details

I. General information

NPI: 1225057698
Provider Name (Legal Business Name): MARK GERARD WURTH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10888 W DODGE RD
OMAHA NE
68154-2609
US

IV. Provider business mailing address

10888 W DODGE RD
OMAHA NE
68154-2609
US

V. Phone/Fax

Practice location:
  • Phone: 402-551-1322
  • Fax: 402-551-3454
Mailing address:
  • Phone: 402-551-1322
  • Fax: 402-551-3454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number817
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: