Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC27190 | CA |
NPI | 1801814181 |
---|---|
Provider Name | David G Wedemeyer |
First Address | Costa Mesa, CA 92627-3153 |
Second Address | Costa Mesa, CA 92627-3153 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 10/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U84616 | (02) |