Provider Demographics
NPI:1740360155
Name:GLENN W WECKEL DC INC
Entity type:Organization
Organization Name:GLENN W WECKEL DC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:W
Authorized Official - Last Name:WECKEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-392-3333
Mailing Address - Street 1:5215 B MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405
Mailing Address - Country:US
Mailing Address - Phone:910-392-3333
Mailing Address - Fax:910-392-3365
Practice Address - Street 1:5215 B MARKET ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405
Practice Address - Country:US
Practice Address - Phone:910-392-3333
Practice Address - Fax:910-392-3365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1595111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7908936Medicaid
NC8908319Medicaid
08936OtherBCBS
08319OtherBCBS
NC7908936Medicaid
244517AMedicare ID - Type Unspecified
NC8908319Medicaid