Provider Demographics
NPI:1194814855
Name:NYBERG, WESLEY JAMES (DC)
Entity type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:JAMES
Last Name:NYBERG
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 1:710 ALICES RD
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-9646
Mailing Address - Country:US
Mailing Address - Phone:515-978-6661
Mailing Address - Fax:515-978-6662
Practice Address - Street 1:710 ALICES RD
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-9646
Practice Address - Country:US
Practice Address - Phone:515-978-6661
Practice Address - Fax:515-978-6662
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06841111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor