Provider Demographics
NPI:1619058930
Name:WEICMAN, SHARON (DC)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:
Last Name:WEICMAN
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 1:115 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-1662
Mailing Address - Country:US
Mailing Address - Phone:203-261-1790
Mailing Address - Fax:203-261-1688
Practice Address - Street 1:115 MAIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-1662
Practice Address - Country:US
Practice Address - Phone:203-261-1790
Practice Address - Fax:203-261-1688
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000725111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050000725CT01Medicare UPIN