Provider Demographics
NPI:1992832893
Name:WIEGAND, AARON LAWRENCE (DC)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:LAWRENCE
Last Name:WIEGAND
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 1:21050 N TATUM BLVD STE 114
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-4261
Mailing Address - Country:US
Mailing Address - Phone:480-585-7463
Mailing Address - Fax:480-383-6064
Practice Address - Street 1:21050 N TATUM BLVD STE 114
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-4261
Practice Address - Country:US
Practice Address - Phone:480-585-7463
Practice Address - Fax:480-383-6064
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7804111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor