Provider Demographics
NPI:1306832183
Name:WIEHE, KENNETH PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:PAUL
Last Name:WIEHE
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:WIEHE CHIROPRACTIC
Mailing Address - Street 2:P O BOX 518 /1202 N MAIN
Mailing Address - City:PARIS
Mailing Address - State:IL
Mailing Address - Zip Code:61944
Mailing Address - Country:US
Mailing Address - Phone:217-465-4171
Mailing Address - Fax:217-465-4172
Practice Address - Street 1:WIEHE CHIROPRACTIC
Practice Address - Street 2:1202 N MAIN
Practice Address - City:PARIS
Practice Address - State:IL
Practice Address - Zip Code:61944-0518
Practice Address - Country:US
Practice Address - Phone:217-465-4171
Practice Address - Fax:217-465-4172
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL06082036OtherBLUE CROSS BLUE SHIELD
IL678070Medicare ID - Type UnspecifiedMEDICARE
ILT37752Medicare UPIN