Provider Demographics
NPI:1619060605
Name:SULAK, WESLEY J (DC)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:J
Last Name:SULAK
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 1:109 PARADISE COVE
Mailing Address - Street 2:
Mailing Address - City:WHITNEY
Mailing Address - State:TX
Mailing Address - Zip Code:76692
Mailing Address - Country:US
Mailing Address - Phone:254-694-7599
Mailing Address - Fax:254-694-7599
Practice Address - Street 1:211 N BRAZOS
Practice Address - Street 2:
Practice Address - City:WHITNEY
Practice Address - State:TX
Practice Address - Zip Code:76692
Practice Address - Country:US
Practice Address - Phone:254-694-7599
Practice Address - Fax:254-694-7599
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC2291111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DD2291Medicare UPIN
600208Medicare ID - Type Unspecified