Healthcare Provider Details

I. General information

NPI: 1063764066
Provider Name (Legal Business Name): RONALD WEDEMEYER PROFESSIONAL CHIROPRACTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2012
Last Update Date: 10/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 MEANY AVE SUITE B
BAKERSFIELD CA
93308-5005
US

IV. Provider business mailing address

7800 MEANY AVE SUITE B
BAKERSFIELD CA
93308-5005
US

V. Phone/Fax

Practice location:
  • Phone: 661-679-7902
  • Fax: 661-679-7923
Mailing address:
  • Phone: 661-679-7902
  • Fax: 661-679-7923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number21162
License Number StateCA

VIII. Authorized Official

Name: CONNIE WEDEMEYER
Title or Position: MANAGER
Credential:
Phone: 661-679-7902