Provider Demographics
NPI:1023176930
Name:WIRTH, RODNEY PAUL (DC)
Entity type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:PAUL
Last Name:WIRTH
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 1:1837 PRINCE JOHN DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-2160
Mailing Address - Country:US
Mailing Address - Phone:214-284-3259
Mailing Address - Fax:972-262-7375
Practice Address - Street 1:2401 AVENUE J STE 210
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-6118
Practice Address - Country:US
Practice Address - Phone:972-802-8812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8086111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
75-2912636OtherTAX ID