1093741407 NPI number — JENNY L WIEMANN D.C.

Table of content: JENNY L WIEMANN D.C. (NPI 1093741407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093741407 NPI number — JENNY L WIEMANN D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WIEMANN
Provider First Name:
JENNY
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CROSBY
Provider Other First Name:
JENNY
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1093741407
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
331A JUNGERMANN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST PETERS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63376-5351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-928-5588
Provider Business Mailing Address Fax Number:
636-922-0071

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
331A JUNGERMANN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST PETERS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63376-5351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-928-5588
Provider Business Practice Location Address Fax Number:
636-922-0071
Provider Enumeration Date:
06/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CE006000 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4319076 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: P00115373 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 3560 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 431738059CRO . This is a "MERCY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 612612 . This is a "ACN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 178092 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 52473 . This is a "GHP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 4407107 . This is a "UHC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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