Healthcare Provider Details

I. General information

NPI: 1992832893
Provider Name (Legal Business Name): AARON LAWRENCE WIEGAND D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21050 N TATUM BLVD STE 114
PHOENIX AZ
85050-4261
US

IV. Provider business mailing address

21050 N TATUM BLVD STE 114
PHOENIX AZ
85050-4261
US

V. Phone/Fax

Practice location:
  • Phone: 480-585-7463
  • Fax: 480-383-6064
Mailing address:
  • Phone: 480-585-7463
  • Fax: 480-383-6064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7804
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: