Provider Demographics
NPI:1982629150
Name:WEDEMEYER, RONALD A (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:A
Last Name:WEDEMEYER
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:PO BOX 469
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-0469
Mailing Address - Country:US
Mailing Address - Phone:575-741-1888
Mailing Address - Fax:
Practice Address - Street 1:118 CAMINO DE LA PLACITA STE C
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6079
Practice Address - Country:US
Practice Address - Phone:575-741-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2019-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21162111N00000X
NMDC2203111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0211620Medicare ID - Type Unspecified
CAU21688Medicare UPIN