Provider Demographics
NPI:1578769675
Name:WETHEY, DAN ARTHUR (DC)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:ARTHUR
Last Name:WETHEY
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:PO BOX 728
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399
Mailing Address - Country:US
Mailing Address - Phone:909-797-1705
Mailing Address - Fax:909-797-6262
Practice Address - Street 1:34569 YUCAIPA BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-4129
Practice Address - Country:US
Practice Address - Phone:909-797-1705
Practice Address - Fax:909-797-6262
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24030111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC240301OtherCHIRO
CADC0240301Medicaid
CADC0240301Medicaid