Provider Demographics
NPI:1356431548
Name:WEIERSTAHL CHIROPRACTIC CLINIC, P.C.
Entity type:Organization
Organization Name:WEIERSTAHL CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARNDT
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:WEIERSTAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:989-723-8864
Mailing Address - Street 1:1089 EAST MAIN
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867
Mailing Address - Country:US
Mailing Address - Phone:989-723-8864
Mailing Address - Fax:989-729-2108
Practice Address - Street 1:1089 EAST MAIN
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867
Practice Address - Country:US
Practice Address - Phone:989-723-8864
Practice Address - Fax:989-729-2108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T96934Medicare UPIN
MI1957016Medicare ID - Type Unspecified