Provider Demographics
NPI:1154368223
Name:PEPPER, WESLEY S (DC)
Entity type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:S
Last Name:PEPPER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109B DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1720
Mailing Address - Country:US
Mailing Address - Phone:304-842-4202
Mailing Address - Fax:304-842-6480
Practice Address - Street 1:109B DOCTORS DR
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1720
Practice Address - Country:US
Practice Address - Phone:304-842-4202
Practice Address - Fax:304-842-6480
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV848111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810006218Medicaid
WVV09259Medicare UPIN
WV4182431Medicare PIN