Provider Demographics
NPI:1871026096
Name:WEYENBERG, RYAN (DC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:WEYENBERG
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 1:3070 FISH HATCHERY RD STE 2
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53713-3187
Mailing Address - Country:US
Mailing Address - Phone:608-274-1945
Mailing Address - Fax:608-237-1254
Practice Address - Street 1:1173 W MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:WHITEWATER
Practice Address - State:WI
Practice Address - Zip Code:53190-1672
Practice Address - Country:US
Practice Address - Phone:262-753-0017
Practice Address - Fax:262-753-0022
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5266111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor