Provider Demographics
NPI:1548464142
Name:WETZEL, ANDRE MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:MICHAEL
Last Name:WETZEL
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 1:908 SUTTERS MILL LN
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:PA
Mailing Address - Zip Code:19560-1146
Mailing Address - Country:US
Mailing Address - Phone:484-794-3235
Mailing Address - Fax:
Practice Address - Street 1:150 MOREVIEW BLVD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:PA
Practice Address - Zip Code:19543-9100
Practice Address - Country:US
Practice Address - Phone:610-286-6626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009358111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor