Provider Demographics
NPI:1922014844
Name:WELSER, DEBRA A (DC)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:A
Last Name:WELSER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:DEBRA
Other - Middle Name:A
Other - Last Name:WILDERMUTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:630 TERRA WEST DR
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-4536
Mailing Address - Country:US
Mailing Address - Phone:815-235-7858
Mailing Address - Fax:815-235-7913
Practice Address - Street 1:630 TERRA WEST DR
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-4536
Practice Address - Country:US
Practice Address - Phone:815-235-7858
Practice Address - Fax:815-235-7913
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-006613111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1043433162OtherGROUP NPI
ILR01169Medicare PIN
IL1043433162OtherGROUP NPI
U12126Medicare UPIN