Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC15066 | CA |
NPI | 1326122193 |
---|---|
Provider Name | Dr. Gary Lee Weddell |
First Address | Chico, CA 95926-3500 |
Second Address | Chico, CA 95926-3500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC0150660 | (02) | CA |