Provider Demographics
NPI:1164466702
Name:WESLEY, PATRICIA SUE (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:SUE
Last Name:WESLEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 FLORIDA AVE S
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2132
Mailing Address - Country:US
Mailing Address - Phone:321-631-2225
Mailing Address - Fax:321-631-2981
Practice Address - Street 1:1014 FLORIDA AVE S
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2132
Practice Address - Country:US
Practice Address - Phone:321-631-2225
Practice Address - Fax:321-631-2981
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8559111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU2743ZMedicare UPIN
FLK9198Medicare ID - Type UnspecifiedGROUP MCR NUMBER