Provider Demographics
NPI:1184629685
Name:WIEGAND, MARK H (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:H
Last Name:WIEGAND
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 1:1 N FIVE POINTS RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4726
Mailing Address - Country:US
Mailing Address - Phone:610-696-4363
Mailing Address - Fax:
Practice Address - Street 1:1 N FIVE POINTS RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4726
Practice Address - Country:US
Practice Address - Phone:610-696-4363
Practice Address - Fax:610-696-4369
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002551-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA197303Medicare PIN