Provider Demographics
NPI:1699719302
Name:WIEGAND, RAYMOND (DC)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:
Last Name:WIEGAND
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 1:5317 ENCHANTED CT
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-5734
Mailing Address - Country:US
Mailing Address - Phone:636-329-8044
Mailing Address - Fax:
Practice Address - Street 1:6034 YOUNG DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-9103
Practice Address - Country:US
Practice Address - Phone:636-329-8774
Practice Address - Fax:636-329-8977
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000148953111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor