Provider Demographics
NPI:1477030732
Name:HARBOUR MEDICAL CENTERS
Entity Type:Organization
Organization Name:HARBOUR MEDICAL CENTERS
Other - Org Name:WIEDNER FAMILY CHIROPRACTIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:WIEDNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-781-1101
Mailing Address - Street 1:1411 SE OCEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-2651
Mailing Address - Country:US
Mailing Address - Phone:772-781-1101
Mailing Address - Fax:772-781-1141
Practice Address - Street 1:1411 SE OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-2651
Practice Address - Country:US
Practice Address - Phone:772-781-1101
Practice Address - Fax:772-781-1141
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WIEDNER FAMILY CHIROPRACTIC PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-19
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7269111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55523OtherMEDICARE PTAN
FL350041521OtherRAILROAD MEDICARE PTAN
FL1790716058OtherNPI