Provider Demographics
NPI:1760629380
Name:DR. TIM WEGSCHEID PA
Entity Type:Organization
Organization Name:DR. TIM WEGSCHEID PA
Other - Org Name:CEDAR CLIFF CHIROPRACTIC & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:E
Authorized Official - Last Name:WEGSCHEID
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-330-3900
Mailing Address - Street 1:2121 CLIFF DR
Mailing Address - Street 2:STE 101
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-3335
Mailing Address - Country:US
Mailing Address - Phone:651-330-3900
Mailing Address - Fax:651-330-3901
Practice Address - Street 1:2121 CLIFF DR
Practice Address - Street 2:STE 101
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-3407
Practice Address - Country:US
Practice Address - Phone:651-330-3900
Practice Address - Fax:651-330-3901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3427111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN50M07WEOtherBCBS GROUP #- TIN #