Provider Demographics
NPI:1437537826
Name:WAKEFIELD CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:WAKEFIELD CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:WELTZIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-435-7521
Mailing Address - Street 1:11081 FOREST PINES DR
Mailing Address - Street 2:STE 104
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-7655
Mailing Address - Country:US
Mailing Address - Phone:919-435-7521
Mailing Address - Fax:
Practice Address - Street 1:11081 FOREST PINES DR
Practice Address - Street 2:STE 104
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-7655
Practice Address - Country:US
Practice Address - Phone:919-435-7521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4276111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty