Provider Demographics
NPI:1205920311
Name:WIESE, PAULA JO (DC)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:JO
Last Name:WIESE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:PAULA
Other - Middle Name:JO
Other - Last Name:RATKOVEC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2500 NORTHVIEW RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-1228
Mailing Address - Country:US
Mailing Address - Phone:402-438-3033
Mailing Address - Fax:402-438-3034
Practice Address - Street 1:2500 NORTHVIEW RD STE 101
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-1228
Practice Address - Country:US
Practice Address - Phone:402-438-3033
Practice Address - Fax:402-438-3034
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1227111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE246252OtherMIDLANDS CHOICE
NE10025326100Medicaid
NE09739Medicare UPIN
NE099748Medicare ID - Type UnspecifiedMEDICARE