Provider Demographics
NPI:1609172683
Name:WESENBERG CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:WESENBERG CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TRISTIN
Authorized Official - Middle Name:VIRGINIA
Authorized Official - Last Name:WESENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:805-650-9106
Mailing Address - Street 1:5850 THILLE ST
Mailing Address - Street 2:204
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-5413
Mailing Address - Country:US
Mailing Address - Phone:805-650-9106
Mailing Address - Fax:805-650-9864
Practice Address - Street 1:5850 THILLE ST
Practice Address - Street 2:204
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5413
Practice Address - Country:US
Practice Address - Phone:805-650-9106
Practice Address - Fax:805-650-9864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25286111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty