Provider Demographics
NPI:1346433208
Name:WIEDRICH, CORI MICHELLE (DC)
Entity type:Individual
Prefix:DR
First Name:CORI
Middle Name:MICHELLE
Last Name:WIEDRICH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 E GRAND AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60046-9094
Mailing Address - Country:US
Mailing Address - Phone:224-643-7281
Mailing Address - Fax:847-589-0746
Practice Address - Street 1:2031 E GRAND AVE STE 301
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:IL
Practice Address - Zip Code:60046-9094
Practice Address - Country:US
Practice Address - Phone:224-643-7281
Practice Address - Fax:847-589-0746
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.010834111N00000X
SC3324111N00000X
IL038010834111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor