Healthcare Provider Details

I. General information

NPI: 1598315327
Provider Name (Legal Business Name): ZACHARY WURTH DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 09/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3940 W CALLA RD
CANFIELD OH
44406-9119
US

IV. Provider business mailing address

3940 W CALLA RD
CANFIELD OH
44406-9119
US

V. Phone/Fax

Practice location:
  • Phone: 712-541-2007
  • Fax:
Mailing address:
  • Phone: 712-541-2007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberINT-00058
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: