Provider Demographics
NPI:1063426260
Name:WIEBE, BRIAN ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ALAN
Last Name:WIEBE
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 1:7029 10TH ST N
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-5938
Mailing Address - Country:US
Mailing Address - Phone:651-735-2201
Mailing Address - Fax:651-739-0763
Practice Address - Street 1:7029 10TH ST N
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-5938
Practice Address - Country:US
Practice Address - Phone:651-735-2201
Practice Address - Fax:651-739-0763
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3361111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN231968OtherACN GROUP, INC.
595R5WIOtherBLUE CROSS BLUE SHIELD
MN201391931OtherHSM
MN590519200Medicaid
350003160Medicare PIN
MN231968OtherACN GROUP, INC.