Provider Demographics
NPI:1669477188
Name:WEBER, DANIEL S (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:S
Last Name:WEBER
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 1:1127 NORTH AVE
Mailing Address - Street 2:STE 21
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-2756
Mailing Address - Country:US
Mailing Address - Phone:802-652-0015
Mailing Address - Fax:802-652-0016
Practice Address - Street 1:1127 NORTH AVE
Practice Address - Street 2:STE 21
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-2756
Practice Address - Country:US
Practice Address - Phone:802-652-0015
Practice Address - Fax:802-652-0016
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006-0001138111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTWEBE68322OtherBCBSVT
VT98L1880OtherLANDMARK
VT4352646OtherCIGNA
VTOVN3529Medicaid
VT98L1880OtherLANDMARK
VTU98341Medicare UPIN