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General NPI Number Information
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NPI Number | 1396935565
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Entity Type | Organization
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Legal Business Name | AHA PA
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 07/25/2007
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Provider Practice Location Address
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Address Line | 603 E 1ST ST
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City | ALICE
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State | TX
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Zip | 78332-4808
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Country | US
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Telephone | 361-664-1181
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Fax | 361-668-3911
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Provider Business Mailing Address
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Address Line | 603 E 1ST ST
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City | ALICE
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State | TX
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Zip | 78332-4808
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Country | US
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Telephone | 361-664-1181
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Fax | 361-668-3911
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Authorized Official
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Title or Position | PRESIDENT
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Name | DEAN DELBERT WIEBEN
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Credential | D.C.
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Telephone | 361-664-1181
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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 | 10005
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License Number State | TX
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