Provider Demographics
NPI:1649799685
Name:WERTZ, RICHARD KARL (MAC, DIPLACC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:KARL
Last Name:WERTZ
Suffix:
Gender:M
Credentials:MAC, DIPLACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 EDISON AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-2532
Mailing Address - Country:US
Mailing Address - Phone:719-580-8916
Mailing Address - Fax:
Practice Address - Street 1:214 EDISON AVE
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2532
Practice Address - Country:US
Practice Address - Phone:719-580-8916
Practice Address - Fax:719-580-8916
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-11
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0002212171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist