Provider Demographics
NPI:1003148008
Name:WEDDLE, NICHOLAS BRETT (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:BRETT
Last Name:WEDDLE
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 1:503 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-2513
Mailing Address - Country:US
Mailing Address - Phone:816-425-5578
Mailing Address - Fax:816-425-5579
Practice Address - Street 1:503 MAIN ST
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-2513
Practice Address - Country:US
Practice Address - Phone:816-425-5578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010001488111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor