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General NPI Number Information
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NPI Number | 1063764066
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Entity Type | Organization
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Legal Business Name | RONALD WEDEMEYER PROFESSIONAL CHIROPRACTIC CORPORATION
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Dates
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Enumeration Date | 10/15/2012
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Last Update Date | 10/15/2012
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Provider Practice Location Address
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Address Line | 7800 MEANY AVE SUITE B
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City | BAKERSFIELD
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State | CA
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Zip | 93308-5005
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Country | US
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Telephone | 661-679-7902
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Fax | 661-679-7923
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Provider Business Mailing Address
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Address Line | 7800 MEANY AVE SUITE B
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City | BAKERSFIELD
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State | CA
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Zip | 93308-5005
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Country | US
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Telephone | 661-679-7902
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Fax | 661-679-7923
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Authorized Official
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Title or Position | MANAGER
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Name | CONNIE WEDEMEYER
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Credential |
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Telephone | 661-679-7902
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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 | 21162
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License Number State | CA
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