Provider Demographics
NPI:1962859611
Name:WIEST, MATHEW (DC)
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:
Last Name:WIEST
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 1:4401 EGAN DRIVE SUITE 100
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378
Mailing Address - Country:US
Mailing Address - Phone:952-746-4162
Mailing Address - Fax:
Practice Address - Street 1:4401 EGAN DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-2024
Practice Address - Country:US
Practice Address - Phone:952-746-4162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6073111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor