Individual
JUSTIN WIETHOP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
12032 TESSON FERRY RD, SAINT LOUIS, MO 63128-1727
(314) 849-1331
(314) 842-9899
Mailing address
1250 PINE TRL, FENTON, MO 63026-4216
(314) 471-8303
(314) 842-9899
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2007001660
MO
Other
Enumeration date
04/13/2007
Last updated
07/08/2007
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