Individual
MRS. MARY ELLEN WIESENFARTH SIMONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
275 W SAN BERNARDINO RD, COVINA, CA 91723-1516
(626) 967-3553
(626) 967-1523
Mailing address
275 W SAN BERNARDINO RD, COVINA, CA 91723-1516
(626) 967-3553
(626) 967-1523
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
DC22891
CA
111NI0013X
Independent Medical Examiner Chiropractor
Primary
DC22891
CA
111NX0100X
Occupational Health Chiropractor
DC22891
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DC22891
LICENSE
CA
Enumeration date
11/21/2011
Last updated
11/21/2019
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