Provider Demographics
NPI:1649687088
Name:HENDRIX, TORY WEGNER (LAC, DACM)
Entity type:Individual
Prefix:
First Name:TORY
Middle Name:WEGNER
Last Name:HENDRIX
Suffix:
Gender:F
Credentials:LAC, DACM
Other - Prefix:
Other - First Name:TORY
Other - Middle Name:
Other - Last Name:WEGNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC, DACM
Mailing Address - Street 1:5532 DUNALLIE DR
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-9202
Mailing Address - Country:US
Mailing Address - Phone:919-561-6858
Mailing Address - Fax:
Practice Address - Street 1:372 RALEIGH ST
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-9047
Practice Address - Country:US
Practice Address - Phone:919-561-6858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC423171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist