Provider Demographics
NPI:1316756570
Name:WENTZ, MATTHEW (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:WENTZ
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 1:17764 SHURMER RD
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-6160
Mailing Address - Country:US
Mailing Address - Phone:440-212-2484
Mailing Address - Fax:
Practice Address - Street 1:12608 ALAMEDA DR
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44149-3029
Practice Address - Country:US
Practice Address - Phone:440-238-3338
Practice Address - Fax:440-238-3329
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-05415111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty