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Individual
DR. JEROME J WIEDEMEIER
Active
Individual
DR. JEROME J WIEDEMEIER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
A5749
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0120493
—
IA
01
—
14184
BLUE CROSS & BLUE SHIELD
IA
01
—
3C972BU
BC/BS OF MN
—
Enumeration date
06/14/2006
Last updated
01/26/2010
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