Provider Demographics
NPI:1215038849
Name:WEADICK, PATRICK D (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:D
Last Name:WEADICK
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 1:1739 E OHIO PIKE
Mailing Address - Street 2:OHIO PIKE CHIROPRACTIC INC
Mailing Address - City:AMELIA
Mailing Address - State:OH
Mailing Address - Zip Code:45102
Mailing Address - Country:US
Mailing Address - Phone:513-797-8262
Mailing Address - Fax:513-797-8274
Practice Address - Street 1:1739 E OHIO PIKE
Practice Address - Street 2:OHIO PIKE CHIROPRACTIC INC
Practice Address - City:AMELIA
Practice Address - State:OH
Practice Address - Zip Code:45102
Practice Address - Country:US
Practice Address - Phone:513-797-8262
Practice Address - Fax:513-797-8274
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1654111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0889810Medicaid
OH0889810Medicaid
OHWE0684791Medicare ID - Type Unspecified