Provider Demographics
NPI:1871279547
Name:WIEST, THOMAS MITCHELL (DC, DIBCN)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MITCHELL
Last Name:WIEST
Suffix:
Gender:M
Credentials:DC, DIBCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5372 NE 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-1673
Mailing Address - Country:US
Mailing Address - Phone:754-799-3852
Mailing Address - Fax:754-799-3739
Practice Address - Street 1:1201 NE 26TH ST STE 106
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1206
Practice Address - Country:US
Practice Address - Phone:754-799-3852
Practice Address - Fax:754-799-3739
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH14572111N00000X, 111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
No111N00000XChiropractic ProvidersChiropractor