Provider Demographics
NPI:1467574988
Name:WEDUL, TED M (DC)
Entity Type:Individual
Prefix:
First Name:TED
Middle Name:M
Last Name:WEDUL
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 1:505 STATE ST
Mailing Address - Street 2:
Mailing Address - City:HOLMEN
Mailing Address - State:WI
Mailing Address - Zip Code:54636-9189
Mailing Address - Country:US
Mailing Address - Phone:608-526-3244
Mailing Address - Fax:
Practice Address - Street 1:505 STATE ST
Practice Address - Street 2:
Practice Address - City:HOLMEN
Practice Address - State:WI
Practice Address - Zip Code:54636-9189
Practice Address - Country:US
Practice Address - Phone:608-526-3244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3828-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38944200Medicaid
WI38944200Medicaid
WI35947Medicare ID - Type Unspecified