Provider Demographics
NPI:1326345729
Name:WIBBENMEYER, LELA (DC)
Entity Type:Individual
Prefix:
First Name:LELA
Middle Name:
Last Name:WIBBENMEYER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LELA
Other - Middle Name:
Other - Last Name:BARTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2520 HIGHWAY K
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-6625
Mailing Address - Country:US
Mailing Address - Phone:636-978-5511
Mailing Address - Fax:
Practice Address - Street 1:2520 HIGHWAY K
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-6625
Practice Address - Country:US
Practice Address - Phone:636-978-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011002178111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor