Provider Demographics
NPI:1689867871
Name:WEISS, MARTIN A (DC)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:A
Last Name:WEISS
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 1:9201 MONTGOMERY BLVD NE BLDG VLL
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2468
Mailing Address - Country:US
Mailing Address - Phone:505-296-7333
Mailing Address - Fax:505-296-5494
Practice Address - Street 1:9201 MONTGOMERY BLVD.N.E.BLDG VLL
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4604
Practice Address - Country:US
Practice Address - Phone:505-296-7333
Practice Address - Fax:505-296-5494
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM573111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
2671561Medicare PIN
NMT41052Medicare UPIN