Organization
LIFE SOURCE CHIROPRACTIC P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON ANDREW WIESE D.C. (CHIROPRACTOR)
(402) 934-4220
Entity
Organization
Contact information
Practice address
15475 RUGGLES ST., 110, OMAHA, NE 68116
(402) 934-4220
Mailing address
15475 RUGGLES ST., 110, OMAHA, NE 68116
(402) 934-4220
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1400
NE
Other
Enumeration date
03/10/2006
Last updated
08/22/2020
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