Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2010001488 | MO |
NPI | 1003148008 |
---|---|
Provider Name | Dr. Nicholas Brett Weddle |
First Address | Belton, MO 64012-2513 |
Second Address | Belton, MO 64012-2513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2010 |
Last Update Date | 05/05/2011 |