Provider Demographics
NPI:1083793749
Name:GENEVIEVE E. WEBER
Entity Type:Organization
Organization Name:GENEVIEVE E. WEBER
Other - Org Name:WEBER CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GENEVIEVE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-324-2335
Mailing Address - Street 1:1008 ADAMS AVE.
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:ND
Mailing Address - Zip Code:58341-1628
Mailing Address - Country:US
Mailing Address - Phone:701-324-2335
Mailing Address - Fax:701-324-4889
Practice Address - Street 1:1008 ADAMS AVE.
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:ND
Practice Address - Zip Code:58341-1628
Practice Address - Country:US
Practice Address - Phone:701-324-2335
Practice Address - Fax:701-324-4889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND361111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND000481OtherSUBMITTER ID FOR EDI
ND14243Medicaid
ND4293OtherMEDICARE FOR EDI
ND12957Medicaid
ND4293OtherMEDICARE FOR EDI
NDT66832Medicare UPIN
NDN1000365Medicare PIN