Provider Demographics
NPI:1710929013
Name:WIEBE, KATHERINE LEE (DC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LEE
Last Name:WIEBE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:LEE
Other - Last Name:LUNDGREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:131 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-3626
Mailing Address - Country:US
Mailing Address - Phone:802-878-4946
Mailing Address - Fax:802-878-9625
Practice Address - Street 1:131 PEARL ST
Practice Address - Street 2:
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-3626
Practice Address - Country:US
Practice Address - Phone:802-878-4946
Practice Address - Fax:802-878-9625
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006-00001098111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTWI VN 2700Medicare PIN
VTU86985Medicare UPIN