Provider Demographics
NPI:1790826873
Name:WIEBE, BRYAN SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:SCOTT
Last Name:WIEBE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 FAUNTLEROY WAY SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-2740
Mailing Address - Country:US
Mailing Address - Phone:206-932-6605
Mailing Address - Fax:206-933-6999
Practice Address - Street 1:4520 FAUNTLEROY WAY SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-2740
Practice Address - Country:US
Practice Address - Phone:206-932-6605
Practice Address - Fax:206-933-6999
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH3113111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor