Provider Demographics
NPI:1962698605
Name:SMITHVILLE CHIROPRACTIC
Entity type:Organization
Organization Name:SMITHVILLE CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:WURTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-532-4774
Mailing Address - Street 1:302 W MEADOW ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SMITHVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64089-9362
Mailing Address - Country:US
Mailing Address - Phone:816-809-6851
Mailing Address - Fax:816-809-6851
Practice Address - Street 1:302 W MEADOW ST
Practice Address - Street 2:SUITE A
Practice Address - City:SMITHVILLE
Practice Address - State:MO
Practice Address - Zip Code:64089-9362
Practice Address - Country:US
Practice Address - Phone:816-809-6851
Practice Address - Fax:816-809-6851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-17
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001013757111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOQ530000Medicare PIN