Provider Demographics
NPI:1164564399
Name:WIEBEN, DEAN DELBERT (DC)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:DELBERT
Last Name:WIEBEN
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 1:603 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4808
Mailing Address - Country:US
Mailing Address - Phone:361-664-1181
Mailing Address - Fax:361-668-3911
Practice Address - Street 1:603 E 1ST ST
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4808
Practice Address - Country:US
Practice Address - Phone:361-664-1181
Practice Address - Fax:361-668-3911
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10005111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8S3930OtherBLUE CROSS
TX8S3930OtherBLUE CROSS
TX611761Medicare ID - Type Unspecified