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General NPI Number Information
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NPI Number | 1750645669
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Entity Type | Individual
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Provider Name | BRADLEY JAMES WIEGAND D.C.
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Gender | Male
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Dates
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Enumeration Date | 06/26/2012
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Last Update Date | 12/21/2015
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Provider Practice Location Address
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Address Line | 4027 S BUSINESS DR
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City | SHEBOYGAN
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State | WI
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Zip | 53081-1261
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Country | US
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Telephone | 920-459-9090
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Fax |
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Provider Business Mailing Address
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Address Line | 126 E MILL ST
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City | PLYMOUTH
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State | WI
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Zip | 53073-1704
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Country | US
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Telephone | 920-892-8920
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Fax | 920-892-8920
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 4891
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License Number State | WI
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