1609172683 NPI number — WESENBERG CHIROPRACTIC CORPORATION

Table of content: BRIANNA CAROL RODRIGUES ACUTE CARE NURSE PRA (NPI 1023571221)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609172683 NPI number — WESENBERG CHIROPRACTIC CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESENBERG CHIROPRACTIC CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609172683
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5850 THILLE ST
Provider Second Line Business Mailing Address:
204
Provider Business Mailing Address City Name:
VENTURA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93003-5413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-650-9106
Provider Business Mailing Address Fax Number:
805-650-9864

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5850 THILLE ST
Provider Second Line Business Practice Location Address:
204
Provider Business Practice Location Address City Name:
VENTURA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93003-5413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-650-9106
Provider Business Practice Location Address Fax Number:
805-650-9864
Provider Enumeration Date:
02/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
WESENBERG
Authorized Official First Name:
TRISTIN
Authorized Official Middle Name:
VIRGINIA
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
805-650-9106

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC25286 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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