Provider Demographics
NPI:1720185689
Name:WECKWORTH, THOMAS VICTOR (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:VICTOR
Last Name:WECKWORTH
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 1:5227 TELEGRAPH RD STE B
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-4182
Mailing Address - Country:US
Mailing Address - Phone:805-644-1442
Mailing Address - Fax:805-644-4923
Practice Address - Street 1:5227 TELEGRAPH RD STE B
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-4182
Practice Address - Country:US
Practice Address - Phone:805-644-1442
Practice Address - Fax:805-644-4923
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11531111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC11531Medicare PIN