Provider Demographics
NPI:1407915937
Name:WEPNER CHIROPRACTIC OFFICE, S.C.
Entity Type:Organization
Organization Name:WEPNER CHIROPRACTIC OFFICE, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:LIN
Authorized Official - Last Name:WEPNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-361-3515
Mailing Address - Street 1:147 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:54923-1621
Mailing Address - Country:US
Mailing Address - Phone:920-361-3515
Mailing Address - Fax:920-361-2733
Practice Address - Street 1:147 N STATE ST
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:WI
Practice Address - Zip Code:54923-1621
Practice Address - Country:US
Practice Address - Phone:920-361-3515
Practice Address - Fax:920-361-2733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1857-012111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38784100Medicaid
WI=========Medicare UPIN