Provider Demographics
NPI:1114227063
Name:WEISS CHIROPRACTIC LIFE CENTER PLC
Entity Type:Organization
Organization Name:WEISS CHIROPRACTIC LIFE CENTER PLC
Other - Org Name:WEISS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-624-9393
Mailing Address - Street 1:44170 W. 12 MILE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377
Mailing Address - Country:US
Mailing Address - Phone:248-624-9393
Mailing Address - Fax:248-624-6010
Practice Address - Street 1:44170 W. 12 MILE RD
Practice Address - Street 2:STE 100
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377
Practice Address - Country:US
Practice Address - Phone:248-624-9393
Practice Address - Fax:248-773-8740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007148111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP99468OtherBCN PROVIDER #
MI3495449Medicaid
MI95035449OtherBCBS PROVIDER #
MI0M69020OtherMEDICARE ID- TYPE UNSPECIFIED
MI168901OtherSELECTCARE PROVIDER #
MI0M69020OtherMEDICARE ID- TYPE UNSPECIFIED
MI3495449Medicaid