Provider Demographics
NPI:1568523355
Name:SPIZZERINCTUM HEALTH CENTRE PC
Entity Type:Organization
Organization Name:SPIZZERINCTUM HEALTH CENTRE PC
Other - Org Name:DR MARTIN A WEISS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:505-296-7333
Mailing Address - Street 1:9201 MONTGOMERY BLVD N.E. BLDG VLL
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111
Mailing Address - Country:US
Mailing Address - Phone:505-296-7333
Mailing Address - Fax:505-296-5494
Practice Address - Street 1:9201 MONTGOMERY BLVD NE BLDG VLL
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2468
Practice Address - Country:US
Practice Address - Phone:505-296-7333
Practice Address - Fax:505-296-5494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM573111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T41052Medicare UPIN
2671561Medicare ID - Type Unspecified