Provider Demographics
NPI:1720154677
Name:WEPNER, TERRY LIN (DC)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:LIN
Last Name:WEPNER
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 1:147 N STATE STREET
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:54923-1621
Mailing Address - Country:US
Mailing Address - Phone:920-361-3515
Mailing Address - Fax:920-361-2733
Practice Address - Street 1:147 N STATE STREET
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:WI
Practice Address - Zip Code:54923-1621
Practice Address - Country:US
Practice Address - Phone:920-361-3515
Practice Address - Fax:920-361-2733
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1857012111N00000X
WI1857111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38784100Medicaid
WI391831491011OtherBCBS
WI000375940Medicare ID - Type Unspecified
WI38784100Medicaid