Provider Demographics
NPI:1336951045
Name:WISHMYER CHIROPRACTIC AND WELLNESS, PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:WISHMYER CHIROPRACTIC AND WELLNESS, PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WISHMYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-500-2875
Mailing Address - Street 1:2095 SAN JOAQUIN HILLS RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-6505
Mailing Address - Country:US
Mailing Address - Phone:949-500-2875
Mailing Address - Fax:949-945-0232
Practice Address - Street 1:2095 SAN JOAQUIN HILLS RD
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-6505
Practice Address - Country:US
Practice Address - Phone:949-500-2875
Practice Address - Fax:949-945-0232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty