Provider Demographics
NPI:1437346061
Name:WEIDNER CHIROPRACTIC OFFICE
Entity Type:Organization
Organization Name:WEIDNER CHIROPRACTIC OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WEIDNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-235-6767
Mailing Address - Street 1:1700 TAINTER ST
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-1358
Mailing Address - Country:US
Mailing Address - Phone:715-235-6767
Mailing Address - Fax:715-234-1441
Practice Address - Street 1:1700 TAINTER ST
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-1358
Practice Address - Country:US
Practice Address - Phone:715-235-6767
Practice Address - Fax:715-234-1441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2204111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI75-830Medicare PIN