Provider Demographics
NPI:1194953505
Name:MENIGOZ, WENDY M (ND)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:M
Last Name:MENIGOZ
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5797 SPRUCE LANE
Mailing Address - Street 2:
Mailing Address - City:ST. ANNE
Mailing Address - State:IL
Mailing Address - Zip Code:60964-5331
Mailing Address - Country:US
Mailing Address - Phone:815-935-1805
Mailing Address - Fax:
Practice Address - Street 1:5797 SPRUCE LANE
Practice Address - Street 2:
Practice Address - City:ST. ANNE
Practice Address - State:IL
Practice Address - Zip Code:60964-5331
Practice Address - Country:US
Practice Address - Phone:815-935-1805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL181.000355172P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172P00000XOther Service ProvidersNaprapath