Provider Demographics
NPI:1386866382
Name:WEGWERTH, HUGH RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:HUGH
Middle Name:RICHARD
Last Name:WEGWERTH
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 1:1912 LEXINGTON AVENUE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-6154
Mailing Address - Country:US
Mailing Address - Phone:651-646-2050
Mailing Address - Fax:651-646-2279
Practice Address - Street 1:1912 LEXINGTON AVENUE
Practice Address - Street 2:SUITE 250
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-6154
Practice Address - Country:US
Practice Address - Phone:651-646-2050
Practice Address - Fax:651-646-2279
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3833111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN76D40WEOtherBLUE CROSS BLUE SHIELD