Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 4388 | AZ |
NPI | 1265417349 |
---|---|
Provider Name | Dr. William Lee Wesselink |
First Address | Tucson, AZ 85718-5687 |
Second Address | Tucson, AZ 85718-5666 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T01076 | (02) | AZ |