Provider Demographics
NPI:1427400142
Name:DOUGLAS D WEBER DC PA
Entity Type:Organization
Organization Name:DOUGLAS D WEBER DC PA
Other - Org Name:WEBER CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-259-0090
Mailing Address - Street 1:402 N BABCOCK ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-7335
Mailing Address - Country:US
Mailing Address - Phone:321-259-0090
Mailing Address - Fax:
Practice Address - Street 1:402 N BABCOCK ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-7335
Practice Address - Country:US
Practice Address - Phone:321-259-0090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7359111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55615Medicaid