Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CHR.0007986 | CO |
NPI | 1003373515 |
---|---|
Provider Name | Alan Wedell |
First Address | Davenport, IA 52804-1721 |
Second Address | Colorado Springs, CO 80922-2605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2019 |
Last Update Date | 21/02/2019 |