Provider Demographics
NPI:1326139973
Name:WESSEL, TREA CANDACE (DC)
Entity Type:Individual
Prefix:DR
First Name:TREA
Middle Name:CANDACE
Last Name:WESSEL
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 1:824 MCMINNVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:TN
Mailing Address - Zip Code:37190-1241
Mailing Address - Country:US
Mailing Address - Phone:615-563-3320
Mailing Address - Fax:615-563-3325
Practice Address - Street 1:824 MCMINNVILLE HWY
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:TN
Practice Address - Zip Code:37190-1241
Practice Address - Country:US
Practice Address - Phone:615-563-3320
Practice Address - Fax:615-563-3325
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1914111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3973145Medicaid
TN5356224OtherCIGNA
TN668746OtherACN
TN9358134OtherPRIVATE HEALTHCARE SYSTEM
TN4079721OtherBLUE CROSS/BLUE SHIELD
TN3973145Medicaid
TN3973145Medicare ID - Type Unspecified