Individual
DR. NATHAN EVAN WIEDRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
2031 E GRAND AVE STE 301, LINDENHURST, IL 60046-9094
(843) 906-0090
(843) 906-0090
Mailing address
2031 E GRAND AVE STE 301, LINDENHURST, IL 60046-9094
(843) 906-0090
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
3342
SC
111N00000X
Chiropractor
3801096
IL
111NR0400X
Rehabilitation Chiropractor
Primary
038.010896
IL
Other
Enumeration date
03/30/2007
Last updated
03/17/2018
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