Provider Demographics
NPI:1326114414
Name:WIGGERS, DEAN EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:EDWARD
Last Name:WIGGERS
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 1:11650 OLIO RD 100
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-7621
Mailing Address - Country:US
Mailing Address - Phone:317-577-1744
Mailing Address - Fax:317-577-1760
Practice Address - Street 1:11650 OLIO RD 100
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-7621
Practice Address - Country:US
Practice Address - Phone:317-577-1744
Practice Address - Fax:317-577-1760
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002187A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200532610Medicaid
IN200532610Medicaid