MEDICARE: CARLOS MARTIN WIEGERING D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC008692	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417940800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS MARTIN WIEGERING D.C.

Provider Business Mailing Address
First Line	:	502 LOGAN BLVD
Second Line	:
City	:	ALTOONA
State	:	PA
Zip	:	16602-4104
Country	:	US
Telephone Number	:	814-944-3536
Fax Number	:	814-941-7660

Provider Business Practice Location Address
First Line	:	502 LOGAN BLVD
Second Line	:
City	:	ALTOONA
State	:	PA
Zip	:	16602-4104
Country	:	US
Telephone Number	:	814-944-3536
Fax Number	:	814-941-7660

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	09/02/2009

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