Provider Demographics
NPI:1215938055
Name:URSPRUNG, WILLIAM MATTHEW (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MATTHEW
Last Name:URSPRUNG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6104 BROADWAY ST # C4
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-4551
Mailing Address - Country:US
Mailing Address - Phone:210-320-0198
Mailing Address - Fax:
Practice Address - Street 1:6104 BROADWAY ST # C4
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-4551
Practice Address - Country:US
Practice Address - Phone:210-320-0198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12088111N00000X
WACH00034633111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8873558OtherMEDICARE PTAN
WA9622UROtherRIDER #
WA8946453OtherWA CRIME VICTIMS COMPENSATION PROGRAM
WA0228670OtherWA STATE L&I #
613078300OtherDOL FECA