Provider Demographics
NPI:1487757878
Name:DALLAS MULTIDISCIPLINARY CLINIC, P.A
Entity type:Organization
Organization Name:DALLAS MULTIDISCIPLINARY CLINIC, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEDDLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-265-9000
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 EXPWY
Practice Address - Street 2:STE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231
Practice Address - Country:US
Practice Address - Phone:214-265-9000
Practice Address - Fax:214-696-1757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6319208100000X
TX6798111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U20711Medicare UPIN
603734Medicare ID - Type Unspecified