Provider Demographics
NPI:1629660964
Name:NIEMELA, WESLEY
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:
Last Name:NIEMELA
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 1:4441 LOCUST GROVE RD
Mailing Address - Street 2:
Mailing Address - City:ROHRERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21779-1003
Mailing Address - Country:US
Mailing Address - Phone:443-996-5170
Mailing Address - Fax:
Practice Address - Street 1:4441 LOCUST GROVE RD
Practice Address - Street 2:
Practice Address - City:ROHRERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21779-1003
Practice Address - Country:US
Practice Address - Phone:443-996-5170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSTUDENTCHIROPRACTOR111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor