Provider Demographics
NPI:1366548331
Name:WEDDLE, BRYAN LEE (DC)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:LEE
Last Name:WEDDLE
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 1:9669 N CENTRAL EXPY
Mailing Address - Street 2:STE 200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-5053
Mailing Address - Country:US
Mailing Address - Phone:214-265-9000
Mailing Address - Fax:214-696-1757
Practice Address - Street 1:9669 N CENTRAL EXPY
Practice Address - Street 2:SUITE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-0200
Practice Address - Country:US
Practice Address - Phone:214-265-9000
Practice Address - Fax:214-696-1757
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC 6798111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU61763Medicare UPIN