Provider Demographics
NPI:1629379664
Name:WETZ CHIROPRACTIC CENTER, P.C.
Entity Type:Organization
Organization Name:WETZ CHIROPRACTIC CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:WETZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-971-4379
Mailing Address - Street 1:1525 CYPRESS CRK STE D
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-3604
Mailing Address - Country:US
Mailing Address - Phone:512-249-6848
Mailing Address - Fax:512-249-9209
Practice Address - Street 1:1525 CYPRESS CRK STE D
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-3604
Practice Address - Country:US
Practice Address - Phone:512-249-6848
Practice Address - Fax:512-249-9209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4308111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4308OtherTEXAS CHIROPRACTIC LICENSE NUMBER
TXU14146OtherUPIN
TXU14146OtherUPIN