Provider Demographics
NPI:1366526998
Name:WURTS, RANDY CARL (DC)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:CARL
Last Name:WURTS
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 1:8657 SANCUS BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43240-4052
Mailing Address - Country:US
Mailing Address - Phone:614-705-6567
Mailing Address - Fax:614-705-6564
Practice Address - Street 1:8657 SANCUS BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240
Practice Address - Country:US
Practice Address - Phone:614-705-6567
Practice Address - Fax:614-705-6564
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3507111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIP09732Medicare ID - Type UnspecifiedPROVIDE NUMBER