Provider Demographics
NPI:1497153852
Name:WEGLEITNER, NICHOLAS
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:WEGLEITNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18202 MINNETONKA BLVD
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-3343
Mailing Address - Country:US
Mailing Address - Phone:612-419-4648
Mailing Address - Fax:
Practice Address - Street 1:18202 MINNETONKA BLVD
Practice Address - Street 2:SUITE 101A
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-3343
Practice Address - Country:US
Practice Address - Phone:612-419-4648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6003111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor