Basic Information
| Provider Information | |||||||||
| NPI: | 1245506112 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HARRY J WURMSDOBLER, DC A PROFESSIONAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 131 E HUNTINGTON DR | ||||||||
| Address2: | |||||||||
| City: | ARCADIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910063212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264450326 | ||||||||
| FaxNumber: | 6264455155 | ||||||||
| Practice Location | |||||||||
| Address1: | 131 E HUNTINGTON DR | ||||||||
| Address2: | |||||||||
| City: | ARCADIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910063212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264450326 | ||||||||
| FaxNumber: | 6264455155 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2012 | ||||||||
| LastUpdateDate: | 04/09/2012 | ||||||||
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| AuthorizedOfficialLastName: | WURMSDOBLER | ||||||||
| AuthorizedOfficialFirstName: | HARRY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6264450326 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0100X | DC20045 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Health Service |
No ID Information.