Provider Demographics
NPI:1083920938
Name:WETZIG, VAN EDWARD (RCMT)
Entity Type:Individual
Prefix:MR
First Name:VAN
Middle Name:EDWARD
Last Name:WETZIG
Suffix:
Gender:M
Credentials:RCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 W OAK ST STE C
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-2893
Mailing Address - Country:US
Mailing Address - Phone:970-231-1214
Mailing Address - Fax:
Practice Address - Street 1:134 W HARVARD ST
Practice Address - Street 2:SUITE 6
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2127
Practice Address - Country:US
Practice Address - Phone:970-231-1214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-28
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO904225700000X
COACU.0002406171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist