Provider Demographics
NPI:1407939127
Name:WIEGAND, BOBBI A (DC)
Entity Type:Individual
Prefix:DR
First Name:BOBBI
Middle Name:A
Last Name:WIEGAND
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 1:2204 N. 7TH ST., STE A & B
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-4413
Mailing Address - Country:US
Mailing Address - Phone:318-322-8535
Mailing Address - Fax:318-387-6610
Practice Address - Street 1:2204 N 7TH ST STE A&B
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-5277
Practice Address - Country:US
Practice Address - Phone:318-322-8535
Practice Address - Fax:318-387-6610
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1163111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAU78865Medicare UPIN
LA4B339Medicare PIN