Provider Demographics
NPI:1255616710
Name:WUERTH, THOMAS JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JAMES
Last Name:WUERTH
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 1:513 MOUNT VERNON LN
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-5370
Mailing Address - Country:US
Mailing Address - Phone:678-358-0251
Mailing Address - Fax:
Practice Address - Street 1:141 MIRRAMONT LAKE DR # 141
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-8257
Practice Address - Country:US
Practice Address - Phone:770-635-7141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008884111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I350649Medicare UPIN