Provider Demographics
NPI:1407972375
Name:WEBER, GEORGE A (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:A
Last Name:WEBER
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:DR
Other - First Name:GEORGE
Other - Middle Name:A
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CHIROPRACTOR
Mailing Address - Street 1:1118 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-2836
Mailing Address - Country:US
Mailing Address - Phone:812-945-6811
Mailing Address - Fax:
Practice Address - Street 1:1118 E MARKET ST
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-2836
Practice Address - Country:US
Practice Address - Phone:812-945-6811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000228A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN241310Medicare ID - Type Unspecified