Provider Demographics
NPI:1407930738
Name:WEDEMEYER, ANALISA (DC)
Entity Type:Individual
Prefix:
First Name:ANALISA
Middle Name:
Last Name:WEDEMEYER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 SHARON PARK DR
Mailing Address - Street 2:SUITE B6
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-6805
Mailing Address - Country:US
Mailing Address - Phone:650-233-7333
Mailing Address - Fax:650-233-7330
Practice Address - Street 1:325 SHARON PARK DR
Practice Address - Street 2:SUITE B6
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-6805
Practice Address - Country:US
Practice Address - Phone:650-233-7333
Practice Address - Fax:650-233-7330
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29562111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC29562OtherCALIFORNIA LICENSE