Provider Demographics
NPI:1952391492
Name:WIBBENMEYER, JANE LOUISE (DC)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:LOUISE
Last Name:WIBBENMEYER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7539 RAVENSRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-5502
Mailing Address - Country:US
Mailing Address - Phone:314-918-8090
Mailing Address - Fax:
Practice Address - Street 1:7539 RAVENSRIDGE RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-5502
Practice Address - Country:US
Practice Address - Phone:314-918-8090
Practice Address - Fax:314-961-2954
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE0005678111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000031343Medicare ID - Type Unspecified