Provider Demographics
NPI:1265072243
Name:WETZEL, RACHEL ALEXANDRA (DC)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:ALEXANDRA
Last Name:WETZEL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 TRADE ST
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-7688
Mailing Address - Country:US
Mailing Address - Phone:631-834-3573
Mailing Address - Fax:
Practice Address - Street 1:1221 BOWER PKWY STE 108
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-3734
Practice Address - Country:US
Practice Address - Phone:631-834-3573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCNA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor