MEDICARE: TROY R WEIDLICH DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH6095	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22956	OTHER		BCBS

General Provider Information

NPI Number	:	1578562914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TROY R WEIDLICH DC

Provider Business Mailing Address
First Line	:	22023 STATE ROAD 7
Second Line	:	SUITE 101
City	:	BOCA RATON
State	:	FL
Zip	:	33428-3401
Country	:	US
Telephone Number	:	561-477-8081
Fax Number	:	561-477-9280

Provider Business Practice Location Address
First Line	:	22023 STATE ROAD 7
Second Line	:	SUITE 101
City	:	BOCA RATON
State	:	FL
Zip	:	33428-3401
Country	:	US
Telephone Number	:	561-477-8081
Fax Number	:	561-477-9280

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	05/28/2009

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Directions to “ TROY R WEIDLICH DC” Practice Location

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