Healthcare Provider Details

I. General information

NPI: 1639258643
Provider Name (Legal Business Name): RYAN MATTHEW WUEBBEN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

568 BROOK FOREST AVE.
SHOREWOOD IL
60404
US

IV. Provider business mailing address

25240 BALMORAL DR
SHOREWOOD IL
60431-8371
US

V. Phone/Fax

Practice location:
  • Phone: 815-725-5733
  • Fax: 815-725-5722
Mailing address:
  • Phone: 563-340-3337
  • Fax: 815-725-5722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: