Provider Demographics
NPI:1699866152
Name:WADLEY, TED A (D C)
Entity type:Individual
Prefix:
First Name:TED
Middle Name:A
Last Name:WADLEY
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11275 E MISSISSIPPI AVE STE 1E8
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-2818
Mailing Address - Country:US
Mailing Address - Phone:303-341-1494
Mailing Address - Fax:303-363-6794
Practice Address - Street 1:11275 E MISSISSIPPI AVE STE 1E8
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-2818
Practice Address - Country:US
Practice Address - Phone:303-341-1494
Practice Address - Fax:303-363-6794
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU39484Medicare UPIN
CO29593Medicare ID - Type Unspecified