Provider Demographics
NPI:1588852834
Name:MARC WEISSMAN DC PLC
Entity Type:Organization
Organization Name:MARC WEISSMAN DC PLC
Other - Org Name:MERCADO CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:E
Authorized Official - Last Name:WEISSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-661-7000
Mailing Address - Street 1:10135 E VIA LINDA STE 115
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5312
Mailing Address - Country:US
Mailing Address - Phone:480-661-7000
Mailing Address - Fax:480-661-0220
Practice Address - Street 1:10135 E VIA LINDA STE 115
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5312
Practice Address - Country:US
Practice Address - Phone:480-661-7000
Practice Address - Fax:480-661-0220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5868111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU78717Medicare UPIN
AZ106851Medicare PIN
AZ106852Medicare PIN