Provider Demographics
NPI:1134135544
Name:WIEBKE, WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:WIEBKE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 HENRY RD
Mailing Address - Street 2:
Mailing Address - City:N MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-2335
Mailing Address - Country:US
Mailing Address - Phone:516-799-6696
Mailing Address - Fax:516-799-2877
Practice Address - Street 1:5516 MERRICK RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-6216
Practice Address - Country:US
Practice Address - Phone:516-799-6696
Practice Address - Fax:516-799-2877
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007754111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYXOB211Medicare ID - Type Unspecified
NY53025Medicare UPIN