=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164680427
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OSTEOPATHIC CONSULTANTS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2008
-----------------------------------------------------
Last Update Date | 05/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1300 N 7TH ST
-----------------------------------------------------
City | GRAND JUNCTION
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81501-3062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-589-0868
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1300 N 7TH ST
-----------------------------------------------------
City | GRAND JUNCTION
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81501-3062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-589-0868
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | DR. PATRICK JOHN WEDLAKE
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 970-589-0868
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 204D00000X
-----------------------------------------------------
Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
-----------------------------------------------------
License Number | 28988
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------