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General NPI Number Information
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NPI Number | 1437346061
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Entity Type | Organization
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Legal Business Name | WEIDNER CHIROPRACTIC OFFICE
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Dates
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Enumeration Date | 09/27/2007
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Last Update Date | 10/05/2007
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Provider Practice Location Address
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Address Line | 1700 TAINTER ST
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City | MENOMONIE
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State | WI
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Zip | 54751-1358
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Country | US
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Telephone | 715-235-6767
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Fax | 715-234-1441
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Provider Business Mailing Address
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Address Line | 1700 TAINTER ST
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City | MENOMONIE
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State | WI
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Zip | 54751-1358
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Country | US
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Telephone | 715-235-6767
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Fax | 715-234-1441
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Authorized Official
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Title or Position | OWNER
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Name | DR. LANCE LEE WEIDNER
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Credential | DC
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Telephone | 715-235-6767
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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 | 2204
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License Number State | WI
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