Healthcare Provider Details

I. General information

NPI: 1982914297
Provider Name (Legal Business Name): WECKER CHIROPRACTIC CENTER, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 12/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 S APOLLO BLVD SUITE 105
MELBOURNE FL
32901-1274
US

IV. Provider business mailing address

551 S APOLLO BLVD SUITE 105
MELBOURNE FL
32901-1274
US

V. Phone/Fax

Practice location:
  • Phone: 321-727-1555
  • Fax:
Mailing address:
  • Phone: 321-727-1555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH3796
License Number StateFL

VIII. Authorized Official

Name: MR. RICHARD J. WECKER
Title or Position: OWNER
Credential: D.C.
Phone: 321-727-1555