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General NPI Number Information
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NPI Number | 1417204538
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Entity Type | Individual
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Provider Name | JONATHAN DAVID WURSTNER D.C.
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Gender | Male
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Dates
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Enumeration Date | 08/08/2012
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Last Update Date | 10/29/2013
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Provider Practice Location Address
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Address Line | 5842 MAIN ST
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-5710
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Country | US
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Telephone | 716-698-5518
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Fax |
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Provider Business Mailing Address
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Address Line | 91 THERESA CT
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City | WEST SENECA
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State | NY
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Zip | 14224-4715
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Country | US
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Telephone | 716-830-1130
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4300
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | X012205-1
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License Number State | NY
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