Provider Demographics
NPI:1942353479
Name:WEGMANN, MICHAEL JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
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 1:3948 POWERS RD
Mailing Address - Street 2:
Mailing Address - City:ALANSON
Mailing Address - State:MI
Mailing Address - Zip Code:49706-9535
Mailing Address - Country:US
Mailing Address - Phone:231-838-4952
Mailing Address - Fax:231-348-5986
Practice Address - Street 1:2000 M-119
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770
Practice Address - Country:US
Practice Address - Phone:231-348-5980
Practice Address - Fax:231-348-5986
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor