Provider Demographics
NPI:1629783618
Name:WEISSBUCH, JOSEPH KIE (LAC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:KIE
Last Name:WEISSBUCH
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 ELLERHORST AVE
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-1427
Mailing Address - Country:US
Mailing Address - Phone:415-717-7979
Mailing Address - Fax:
Practice Address - Street 1:2610 ELLERHORST AVE
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-1427
Practice Address - Country:US
Practice Address - Phone:415-717-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51197225700000X
CA19537171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist