Provider Demographics
NPI:1699906347
Name:WEEKES, WALLACE COREY (DC)
Entity type:Individual
Prefix:DR
First Name:WALLACE
Middle Name:COREY
Last Name:WEEKES
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 1:443 WRIGHT ST APT 308
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1155
Mailing Address - Country:US
Mailing Address - Phone:720-229-3795
Mailing Address - Fax:
Practice Address - Street 1:400 INDIANA ST STE 320
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-5033
Practice Address - Country:US
Practice Address - Phone:720-722-3392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01277111N00000X
AZ7811111N00000X
CO6386111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor