Provider Demographics
NPI:1043079056
Name:WIEMERS, KIRA ALYSSE (DC)
Entity Type:Individual
Prefix:DR
First Name:KIRA
Middle Name:ALYSSE
Last Name:WIEMERS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MISS
Other - First Name:KIRA
Other - Middle Name:ALYSSE
Other - Last Name:VANCLEVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1505 SPRINGDALE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOREB
Mailing Address - State:WI
Mailing Address - Zip Code:53572-2069
Mailing Address - Country:US
Mailing Address - Phone:608-437-5585
Mailing Address - Fax:
Practice Address - Street 1:1505 SPRINGDALE ST
Practice Address - Street 2:
Practice Address - City:MOUNT HOREB
Practice Address - State:WI
Practice Address - Zip Code:53572-2069
Practice Address - Country:US
Practice Address - Phone:608-437-5585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6178-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor