Healthcare Provider Details

I. General information

NPI: 1821266230
Provider Name (Legal Business Name): BRIAN LYNN WIGGEN II II CO. BOCO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 EAST WALKER ST
EAST FLAT ROCK NC
28726
US

IV. Provider business mailing address

107 EAST WALKER ST.
EAST FLAT ROCK NC
28726
US

V. Phone/Fax

Practice location:
  • Phone: 828-595-9371
  • Fax: 828-595-9373
Mailing address:
  • Phone: 828-595-9371
  • Fax: 828-595-9373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: