Provider Demographics
NPI:1366504185
Name:WEBER, EUGENE CARL (DC)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:CARL
Last Name:WEBER
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 1:3802 TIETON DR
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3666
Mailing Address - Country:US
Mailing Address - Phone:509-965-7155
Mailing Address - Fax:509-965-0730
Practice Address - Street 1:3802 TIETON DR
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3666
Practice Address - Country:US
Practice Address - Phone:509-965-7155
Practice Address - Fax:509-965-0730
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0002528111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAWE7890OtherREGENCE
WA34843OtherLABOR & INDUSTRIES
WAWE7890OtherREGENCE