Provider Demographics
NPI:1235298605
Name:WEISER, ZACHARY DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:DAVID
Last Name:WEISER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 S WASHINGTON SQ
Mailing Address - Street 2:ATTENTION CHIROPRACTOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-4118
Mailing Address - Country:US
Mailing Address - Phone:215-925-8005
Mailing Address - Fax:215-925-8005
Practice Address - Street 1:604 S WASHINGTON SQ
Practice Address - Street 2:ATTENTION CHIROPRACTOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-4118
Practice Address - Country:US
Practice Address - Phone:215-925-8005
Practice Address - Fax:215-925-8005
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC5448L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01616760Medicaid
PA750455RRVMedicare ID - Type Unspecified
PA01616760Medicaid