Provider Demographics
NPI:1063764066
Name:RONALD WEDEMEYER PROFESSIONAL CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:RONALD WEDEMEYER PROFESSIONAL CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEDEMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-679-7902
Mailing Address - Street 1:7800 MEANY AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-5005
Mailing Address - Country:US
Mailing Address - Phone:661-679-7902
Mailing Address - Fax:661-679-7923
Practice Address - Street 1:7800 MEANY AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-5005
Practice Address - Country:US
Practice Address - Phone:661-679-7902
Practice Address - Fax:661-679-7923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21162111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU21688Medicare UPIN