Provider Demographics
NPI:1679098545
Name:WEBER, ROSS JAY (DC)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:JAY
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 1:7951 NE BAYSHORE CT # E1603
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33138-6399
Mailing Address - Country:US
Mailing Address - Phone:954-461-1219
Mailing Address - Fax:
Practice Address - Street 1:2645 SW 37TH AVE STE 504B
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-2754
Practice Address - Country:US
Practice Address - Phone:305-389-9040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12274111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor