Provider Demographics
NPI:1467626218
Name:EDWARD J WETZORK DC PA
Entity Type:Organization
Organization Name:EDWARD J WETZORK DC PA
Other - Org Name:KERNAN CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:WETZORK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-338-9400
Mailing Address - Street 1:11900 ATLANTIC BLVD
Mailing Address - Street 2:SUITE 226
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-2920
Mailing Address - Country:US
Mailing Address - Phone:904-338-9400
Mailing Address - Fax:
Practice Address - Street 1:11900 ATLANTIC BLVD
Practice Address - Street 2:SUITE 226
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-2920
Practice Address - Country:US
Practice Address - Phone:904-338-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8031111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5163Medicare PIN