Provider Demographics
NPI:1275698169
Name:KRISTEN WEBER, DC
Entity Type:Organization
Organization Name:KRISTEN WEBER, DC
Other - Org Name:COPP CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-833-0410
Mailing Address - Street 1:331 COTUIT RD
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02563-2434
Mailing Address - Country:US
Mailing Address - Phone:508-833-0410
Mailing Address - Fax:508-888-4007
Practice Address - Street 1:331 COTUIT RD
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02563-2434
Practice Address - Country:US
Practice Address - Phone:508-833-0410
Practice Address - Fax:508-888-4007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY39782OtherBCBS MA
MAY49144Medicare PIN