Provider Demographics
NPI:1346355419
Name:WEISS CHIROPRACTIC INC
Entity Type:Organization
Organization Name:WEISS CHIROPRACTIC INC
Other - Org Name:DR MARC D WEISS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:DANA
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-328-3031
Mailing Address - Street 1:2410 TORRANCE BLVD
Mailing Address - Street 2:STE D
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501
Mailing Address - Country:US
Mailing Address - Phone:310-328-3031
Mailing Address - Fax:310-328-4031
Practice Address - Street 1:2410 TORRANCE BLVD
Practice Address - Street 2:STE D
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501
Practice Address - Country:US
Practice Address - Phone:310-328-3031
Practice Address - Fax:310-328-4031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC15479111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T18075Medicare UPIN