Provider Demographics
NPI:1568797504
Name:WEBER CHIROPRACTIC CLINIC, INC. P.S.
Entity Type:Organization
Organization Name:WEBER CHIROPRACTIC CLINIC, INC. P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-965-7155
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-08
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0002528111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA000119634Medicare UPIN