Active NPI
Gregory Haylett Weidlich, D.C.
- Chiropractor
- Lake Oswego, OR
National Provider Identifier
1477849693
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 3432
- Practice address
- 16869 65TH Ave # 356
Lake Oswego, OR 97035-7865 - Phone
- (503) 336-1287
- NPI assigned
- Jun 27, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 3432 | OR | Primary |
Addresses
Primary practice location
16869 65TH Ave # 356
Lake Oswego, OR 97035-7865
Mailing address
PO Box 1368
Lake Oswego, OR 97035-0536
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 963 | MT | MD | Addiction (Substance Use Disorder) Counselor |
Interoperability endpoints
- gregory.weidlich.1@17650.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309132800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1309132800000",
"number": "1477849693",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1368",
"city": "LAKE OSWEGO",
"state": "OR",
"postal_code": "970350536"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16869 65TH AVE # 356",
"city": "LAKE OSWEGO",
"state": "OR",
"postal_code": "970357865",
"telephone_number": "503-336-1287"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEIDLICH",
"first_name": "GREGORY",
"middle_name": "HAYLETT",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-06-27",
"last_updated": "2011-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "OR",
"license": "3432",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Oswego, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.