Provider Demographics
NPI:1932133097
Name:WEGMANN, JOHN HENRY (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HENRY
Last Name:WEGMANN
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 1:309 SOUTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH
Mailing Address - State:IL
Mailing Address - Zip Code:61462-2111
Mailing Address - Country:US
Mailing Address - Phone:309-734-2447
Mailing Address - Fax:309-734-0749
Practice Address - Street 1:309 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:MONMOUTH
Practice Address - State:IL
Practice Address - Zip Code:61462-2111
Practice Address - Country:US
Practice Address - Phone:309-734-2447
Practice Address - Fax:309-734-0749
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038608010111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038008010Medicaid
IL038008010Medicaid
U62661Medicare UPIN
IL207148Medicare ID - Type UnspecifiedGROUP