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General NPI Number Information
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NPI Number | 1043526270
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Entity Type | Organization
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Legal Business Name | WIBBENMEYER CHIROPRACTIC
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Dates
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Enumeration Date | 08/25/2010
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Last Update Date | 08/25/2010
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Provider Practice Location Address
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Address Line | 7539 RAVENSRIDGE RD
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City | SAINT LOUIS
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State | MO
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Zip | 63119-5502
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Country | US
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Telephone | 314-918-8090
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Fax | 314-961-2954
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Provider Business Mailing Address
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Address Line | 7539 RAVENSRIDGE RD
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City | SAINT LOUIS
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State | MO
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Zip | 63119-5502
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Country | US
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Telephone | 314-918-8090
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Fax | 314-961-2954
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | JANE L WIBBENMEYER
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Credential | DC
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Telephone | 314-918-8030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CE005678
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License Number State | MO
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