Provider Demographics
NPI:1871968032
Name:WIEDNER FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:WIEDNER FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:VEIGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-781-1101
Mailing Address - Street 1:931 SE OCEAN BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2425
Mailing Address - Country:US
Mailing Address - Phone:772-781-1101
Mailing Address - Fax:772-781-1141
Practice Address - Street 1:931 SE OCEAN BLVD STE C
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2425
Practice Address - Country:US
Practice Address - Phone:772-781-1101
Practice Address - Fax:772-781-1141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7269261Q00000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL350041521OtherRAILROAD MEDICARE PTAN
FL55523OtherMEDICARE PTAN
FL55523OtherBLUE CROSS / BLUE SHIELD PTAN