Provider Demographics
NPI:1467544379
Name:WEDDLE, KIM (DC, APCP)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:
Last Name:WEDDLE
Suffix:
Gender:F
Credentials:DC, APCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 BRADBURY DR SE
Mailing Address - Street 2:STE 2222
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4374
Mailing Address - Country:US
Mailing Address - Phone:505-272-3002
Mailing Address - Fax:
Practice Address - Street 1:4700 JEFFERSON ST NE
Practice Address - Street 2:STE 100
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2136
Practice Address - Country:US
Practice Address - Phone:505-925-7464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1889111N00000X
CADC26823111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0350Medicare UPIN
CADC26823Medicare ID - Type Unspecified