Provider Demographics
NPI:1306847132
Name:WESLEY, JIMMY TODD (DC)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:TODD
Last Name:WESLEY
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 1:5408 BELL ST
Mailing Address - Street 2:STE 150 A
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-6222
Mailing Address - Country:US
Mailing Address - Phone:806-463-2225
Mailing Address - Fax:806-463-2227
Practice Address - Street 1:5408 BELL ST
Practice Address - Street 2:STE 150 A
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-6222
Practice Address - Country:US
Practice Address - Phone:806-463-2225
Practice Address - Fax:806-463-2227
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8194111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5103762OtherAETNA
TXP00089627OtherMEDICARE RAILROAD
TX5103762OtherAETNA
TXP00089627OtherMEDICARE RAILROAD