Provider Demographics
NPI:1922326420
Name:ERIC A. WIEGANDT, P.A.
Entity Type:Organization
Organization Name:ERIC A. WIEGANDT, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:A
Authorized Official - Last Name:WIEGANDT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-441-2145
Mailing Address - Street 1:220 MIRACLE MILE
Mailing Address - Street 2:SUITE200
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5910
Mailing Address - Country:US
Mailing Address - Phone:305-441-2145
Mailing Address - Fax:305-445-4869
Practice Address - Street 1:220 MIRACLE MILE
Practice Address - Street 2:SUITE200
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5910
Practice Address - Country:US
Practice Address - Phone:305-441-2145
Practice Address - Fax:305-445-4869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8733111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty