Provider Demographics
NPI:1003116385
Name:WIERSIG CHIROPRACTIC INC
Entity Type:Organization
Organization Name:WIERSIG CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:DARREN
Authorized Official - Last Name:WIERSIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-737-5653
Mailing Address - Street 1:2013 S. AIR DEPOT BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-5523
Mailing Address - Country:US
Mailing Address - Phone:405-737-5653
Mailing Address - Fax:405-733-5656
Practice Address - Street 1:2013 S. AIR DEPOT BLVD
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-5523
Practice Address - Country:US
Practice Address - Phone:405-737-5653
Practice Address - Fax:405-733-5656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3048302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKA102034OtherPTAN
OKT91026Medicare UPIN