Provider Demographics
NPI:1093741407
Name:WIEMANN, JENNY L (DC)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:L
Last Name:WIEMANN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:L
Other - Last Name:CROSBY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:331A JUNGERMANN RD
Mailing Address - Street 2:
Mailing Address - City:ST PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-5351
Mailing Address - Country:US
Mailing Address - Phone:636-928-5588
Mailing Address - Fax:636-922-0071
Practice Address - Street 1:331A JUNGERMANN RD
Practice Address - Street 2:
Practice Address - City:ST PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-5351
Practice Address - Country:US
Practice Address - Phone:636-928-5588
Practice Address - Fax:636-922-0071
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE006000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4319076OtherAETNA
MOP00115373OtherRAILROAD MEDICARE
MO3560OtherBLUE CROSS BLUE SHIELD
MO431738059CROOtherMERCY
MO612612OtherACN
MO178092OtherHEALTHLINK
MO52473OtherGHP
MO4407107OtherUHC
MO3560OtherBLUE CROSS BLUE SHIELD
MOU29655Medicare UPIN