Individual
DR. KENNETH LEON WECKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
23440 SE STARK ST, GRESHAM, OR 97030-2961
(503) 489-6245
(503) 489-0552
Mailing address
23440 SE STARK ST, GRESHAM, OR 97030-2961
(503) 489-6245
(503) 489-0552
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
713726
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36-4626648
TAX ID#
OR
Enumeration date
03/28/2007
Last updated
01/22/2009
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