Travis Jordan Wetzel, DC
Individual provider Active NPI Chiropractor · Prescott, AZ
NPI 1114462157 · NPPES record last updated Feb 21, 2024
Key facts
- NPI
- 1114462157
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 8604 (AZ)
- Practice address
- 3191 Stillwater Dr Ste B
Prescott, AZ 86305-7145 - Phone
- (928) 771-9400
- Fax
- (928) 771-9464
- NPI assigned
- Dec 29, 2016
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Palmer College Chiropractic - Davenport, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Bennett Clinic LLC
Practice addresses (Care Compare)
3191 Stillwater Dr
Suite B
Prescott, AZ 86305-7143
3191 Stillwater Dr
Suite B
Prescott, AZ 86305-7145
Phone (928) 771-9400
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170526001039 | AZ | Practitioner - Chiropractic | 0941577720 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8604 | AZ | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bennett Clinic LLC | Current |
Accepting new patients | |
| Bennett Clinic LLC | Current |
Accepting new patients | |
| Weisbrod Chiropractic, Inc. | Chiropractor | Past |
Accepting new patients |
Locations
3191 Stillwater Dr
Ste B
Prescott, AZ 86305
Phone (928) 212-1479
1202 Willow Creek Rd
Prescott, AZ 86301
Phone (928) 771-9400
Interoperability endpoints
- travis.wetzel.1@29676.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 8604 | AZ | Yes |
Addresses
Primary practice location
3191 Stillwater Dr Ste B
Prescott, AZ 86305-7145
Mailing address
3191 Stillwater Dr Ste B
Prescott, AZ 86305-7145
Phone (928) 771-9400
Other providers in Prescott, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 21, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.