Provider Demographics
NPI:1962681296
Name:WEIDLER, CHRISTOPHER WESTPHAL (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:WESTPHAL
Last Name:WEIDLER
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 1:62 PINNACLE DR
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2086
Mailing Address - Country:US
Mailing Address - Phone:631-512-8226
Mailing Address - Fax:
Practice Address - Street 1:62 PINNACLE DR
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2086
Practice Address - Country:US
Practice Address - Phone:631-512-8226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011434-1111N00000X
246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic