Provider Demographics
NPI:1710374327
Name:WIGNER, STEPHANIE LEEANN (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:LEEANN
Last Name:WIGNER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 GREEN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08757-5116
Mailing Address - Country:US
Mailing Address - Phone:620-253-5567
Mailing Address - Fax:
Practice Address - Street 1:3156 ROUTE 88
Practice Address - Street 2:SUITE 1
Practice Address - City:POINT PLEASANT BORO
Practice Address - State:NJ
Practice Address - Zip Code:08742-2885
Practice Address - Country:US
Practice Address - Phone:732-295-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00725800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor