Provider Demographics
NPI:1144230319
Name:WECKER, RICHARD J (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:WECKER
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 1:551 S APOLLO BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1274
Mailing Address - Country:US
Mailing Address - Phone:321-727-1555
Mailing Address - Fax:321-725-1705
Practice Address - Street 1:551 S APOLLO BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1274
Practice Address - Country:US
Practice Address - Phone:321-727-1555
Practice Address - Fax:321-725-1705
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3796111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050957400Medicaid
FL593195183OtherEIN
FL593195183OtherEIN
FLU20534Medicare UPIN