Provider Demographics
NPI:1578530200
Name:WEISS, CETTY M (DC)
Entity Type:Individual
Prefix:DR
First Name:CETTY
Middle Name:M
Last Name:WEISS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:BRADLEY
Other - Middle Name:G
Other - Last Name:WEISS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:11924 W FOREST HILL BLVD
Mailing Address - Street 2:SUITE 13
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6256
Mailing Address - Country:US
Mailing Address - Phone:561-753-6077
Mailing Address - Fax:561-753-6095
Practice Address - Street 1:11924 W FOREST HILL BLVD
Practice Address - Street 2:SUITE 13
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6256
Practice Address - Country:US
Practice Address - Phone:561-753-6077
Practice Address - Fax:561-753-6095
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5180111N00000X
FL5181111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70730Medicare ID - Type Unspecified
FLT85495Medicare UPIN
FL70729Medicare ID - Type Unspecified