Provider Demographics
NPI:1598864670
Name:WEIDLER, LINDA L (DC)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:L
Last Name:WEIDLER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 US 401 HWY S
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549-9043
Mailing Address - Country:US
Mailing Address - Phone:919-496-4664
Mailing Address - Fax:919-496-7930
Practice Address - Street 1:1165 US 401 HWY S
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-9043
Practice Address - Country:US
Practice Address - Phone:919-496-4664
Practice Address - Fax:919-496-7930
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1470111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908972Medicaid
NC08972OtherBCBS ID #
NC350042967OtherRAILROAD MEDICARE
NC5737144OtherAETNA ID #
NC244483AMedicare ID - Type UnspecifiedMEDICARE PROVIDER #
NC08972OtherBCBS ID #
NC2448774Medicare ID - Type UnspecifiedMEDICARE GROUP #