Provider Demographics
NPI:1518265362
Name:WEISS, NATHAN A (DC)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:A
Last Name:WEISS
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 1:2100 S COLUMBIA RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-5895
Mailing Address - Country:US
Mailing Address - Phone:701-757-2225
Mailing Address - Fax:701-757-0740
Practice Address - Street 1:2100 S COLUMBIA RD
Practice Address - Street 2:SUITE 114
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-5895
Practice Address - Country:US
Practice Address - Phone:701-757-2225
Practice Address - Fax:701-757-0740
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5557111N00000X
MN897171100000X
ND890111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1518265362Medicaid
ND16542Medicaid
ND16542Medicaid