Provider Demographics
NPI:1609098441
Name:WEBER, JENNIFER SUE (DC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SUE
Last Name:WEBER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30491 - 240TH ST
Mailing Address - Street 2:
Mailing Address - City:HARPER
Mailing Address - State:IA
Mailing Address - Zip Code:52231
Mailing Address - Country:US
Mailing Address - Phone:641-635-2001
Mailing Address - Fax:641-635-2001
Practice Address - Street 1:101 W HWY 78 UNIT 2
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:IA
Practice Address - Zip Code:52585
Practice Address - Country:US
Practice Address - Phone:319-456-2083
Practice Address - Fax:319-456-2086
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06866111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA09744OtherWELLMARK
IAV09077Medicare UPIN
IAI17425Medicare ID - Type Unspecified