Provider Demographics
NPI:1174577233
Name:WEDDLE, CARY ANN (DC)
Entity type:Individual
Prefix:
First Name:CARY
Middle Name:ANN
Last Name:WEDDLE
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:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:RAINIER
Mailing Address - State:OR
Mailing Address - Zip Code:97048-0097
Mailing Address - Country:US
Mailing Address - Phone:360-957-4929
Mailing Address - Fax:
Practice Address - Street 1:1329 BROADWAY ST
Practice Address - Street 2:STE 200
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3747
Practice Address - Country:US
Practice Address - Phone:360-957-4929
Practice Address - Fax:360-578-2930
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034320111N00000X
OR273037111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0052630OtherWORKERS COMPENSATION
WA2029775Medicaid
WA8855303Medicare PIN
WA0052630OtherWORKERS COMPENSATION