Individual provider Active NPI

Bryan Lee Weddle, D.C

  • Chiropractor
  • Dallas, TX
National Provider Identifier
1366548331
Registry record updated Jan 31, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
DC 6798 Issued in TX
Practice address
9669 N Central Expy
Suite 200
Dallas, TX 75231-0200
Phone
(214) 265-9000
Fax
(214) 696-1757
NPI assigned
Sep 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X DC 6798 TX Primary

Addresses

Primary practice location

9669 N Central Expy
Suite 200
Dallas, TX 75231-0200

Mailing address

9669 N Central Expy
Ste 200
Dallas, TX 75231-5053
Phone (214) 265-9000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070927000633 TX Practitioner - Chiropractic 8921192667

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DC 6798TXMDChiropractor

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359590400000",
    "number": "1366548331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9669 N CENTRAL EXPY",
            "address_2": "STE 200",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752315053",
            "telephone_number": "214-265-9000",
            "fax_number": "214-696-1757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9669 N CENTRAL EXPY",
            "address_2": "SUITE 200",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752310200",
            "telephone_number": "214-265-9000",
            "fax_number": "214-696-1757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEDDLE",
        "first_name": "BRYAN",
        "middle_name": "LEE",
        "credential": "D.C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-16",
        "last_updated": "2013-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "DC 6798",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.