Healthcare Provider Details

I. General information

NPI: 1578562914
Provider Name (Legal Business Name): TROY R WEIDLICH DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22023 STATE ROAD 7 SUITE 101
BOCA RATON FL
33428-3401
US

IV. Provider business mailing address

22023 STATE ROAD 7 SUITE 101
BOCA RATON FL
33428-3401
US

V. Phone/Fax

Practice location:
  • Phone: 561-477-8081
  • Fax: 561-477-9280
Mailing address:
  • Phone: 561-477-8081
  • Fax: 561-477-9280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH6095
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: