Provider Demographics
NPI:1346286135
Name:WESENBERG, TRISTIN VIRGINIA (DOCTOR OF CHIROPRACT)
Entity Type:Individual
Prefix:MS
First Name:TRISTIN
Middle Name:VIRGINIA
Last Name:WESENBERG
Suffix:
Gender:F
Credentials:DOCTOR OF CHIROPRACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:5850 THILLE ST
Mailing Address - Street 2:204
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-5413
Mailing Address - Country:US
Mailing Address - Phone:805-650-9106
Mailing Address - Fax:805-650-9864
Practice Address - Street 1:5850 THILLE STREET
Practice Address - Street 2:204
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-9003
Practice Address - Country:US
Practice Address - Phone:805-650-9106
Practice Address - Fax:805-650-9864
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25286111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor