Healthcare Provider Details

I. General information

NPI: 1326156498
Provider Name (Legal Business Name): NATHANIEL SELVYN WIRT PHD DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 NASA RD I SUITE 101
SEABROOK TX
77586
US

IV. Provider business mailing address

PO BOX 216 2600 NASA RD I SUITE 101
SEABROOK TX
77586
US

V. Phone/Fax

Practice location:
  • Phone: 281-532-9466
  • Fax:
Mailing address:
  • Phone: 281-532-9466
  • Fax: 281-532-9466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2909
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: