Provider Demographics
NPI:1164853727
Name:WIEMOLD, KATHLEEN (DC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:WIEMOLD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10126 BROOKS SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-9575
Mailing Address - Country:US
Mailing Address - Phone:317-225-1197
Mailing Address - Fax:
Practice Address - Street 1:10126 BROOKS SCHOOL RD
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9575
Practice Address - Country:US
Practice Address - Phone:317-225-1197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-09
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002748A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor