Provider Demographics
NPI:1679652424
Name:WETZEN, THOMAS JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOHN
Last Name:WETZEN
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 1:300 N WASHINGTON ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3438
Mailing Address - Country:US
Mailing Address - Phone:703-560-4730
Mailing Address - Fax:703-560-4731
Practice Address - Street 1:300 N WASHINGTON ST
Practice Address - Street 2:SUITE 103
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3438
Practice Address - Country:US
Practice Address - Phone:703-560-4730
Practice Address - Fax:703-560-4731
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001865111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG01825F01Medicare PIN
VA139135Medicare UPIN