Provider Demographics
NPI:1609988286
Name:WEISBERG, JOHN ERNEST (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ERNEST
Last Name:WEISBERG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 S. 16TH ST.
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401
Mailing Address - Country:US
Mailing Address - Phone:910-352-2723
Mailing Address - Fax:910-343-1178
Practice Address - Street 1:1375 S. 16TH ST.
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401
Practice Address - Country:US
Practice Address - Phone:910-352-2723
Practice Address - Fax:910-343-1178
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX-003440-1111NN1001X
NC1371111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY087211Medicare PIN
NYT86344Medicare UPIN