Basic Information
| Provider Information | |||||||||
| NPI: | 1003148008 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEDDLE | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | BRETT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.C. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 503 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BELTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640122513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164255578 | ||||||||
| FaxNumber: | 8164255579 | ||||||||
| Practice Location | |||||||||
| Address1: | 503 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BELTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640122513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164255578 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2010 | ||||||||
| LastUpdateDate: | 05/05/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 2010001488 | MO | Y | Chiropractic Providers | Chiropractor |
No ID Information.