Provider Demographics
NPI:1689630907
Name:WEISSMAN, MARC EVAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:EVAN
Last Name:WEISSMAN
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 1:10135 E VIA LINDA
Mailing Address - Street 2:SUITE 115
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5328
Mailing Address - Country:US
Mailing Address - Phone:480-661-7000
Mailing Address - Fax:480-661-0220
Practice Address - Street 1:10135 E VIA LINDA
Practice Address - Street 2:SUITE 115
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5328
Practice Address - Country:US
Practice Address - Phone:480-661-7000
Practice Address - Fax:480-661-0220
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5868111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ106852Medicare PIN
AZU78717Medicare UPIN
Z106851Medicare PIN