Provider Demographics
NPI:1144228545
Name:WEDELL, TED A (DC)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:A
Last Name:WEDELL
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 1:6515 132ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-8628
Mailing Address - Country:US
Mailing Address - Phone:425-822-4326
Mailing Address - Fax:425-827-3572
Practice Address - Street 1:6515 132ND AVE NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-8628
Practice Address - Country:US
Practice Address - Phone:425-822-4326
Practice Address - Fax:425-827-3572
Is Sole Proprietor?:No
Enumeration Date:2005-07-09
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3447111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB10964Medicare ID - Type Unspecified
U76530Medicare UPIN