Provider Demographics
NPI:1912009788
Name:WESELAK, TIMOTHY CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:CHARLES
Last Name:WESELAK
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 1:1127 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-3948
Mailing Address - Country:US
Mailing Address - Phone:630-629-9500
Mailing Address - Fax:630-629-9501
Practice Address - Street 1:1127 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-3948
Practice Address - Country:US
Practice Address - Phone:630-629-9500
Practice Address - Fax:630-629-9501
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009282111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00416153OtherRAILROAD MEDICARE
IL0002232693OtherBCBS
ILK20196Medicare ID - Type UnspecifiedINDIVIDUAL