Provider Demographics
NPI:1295867356
Name:WEIDE CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:WEIDE CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ANSON
Authorized Official - Last Name:WEIDE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:414-768-9000
Mailing Address - Street 1:7280 S 13TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-1831
Mailing Address - Country:US
Mailing Address - Phone:414-768-9000
Mailing Address - Fax:414-768-9004
Practice Address - Street 1:7280 S 13TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-1831
Practice Address - Country:US
Practice Address - Phone:414-768-9000
Practice Address - Fax:414-768-9004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1599-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38780400Medicaid
WIT63627Medicare UPIN