Provider Demographics
NPI:1295381531
Name:WEBER, TONYA CANDICE
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:CANDICE
Last Name:WEBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2051 MARSH FLOWER LN
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-6435
Mailing Address - Country:US
Mailing Address - Phone:843-653-8901
Mailing Address - Fax:
Practice Address - Street 1:1016 2ND AVE N STE 205
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-3288
Practice Address - Country:US
Practice Address - Phone:843-653-8007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC95171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist