Provider Demographics
NPI:1689911596
Name:WEBER, BEN EDWARD (DC)
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:EDWARD
Last Name:WEBER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:BEN
Other - Middle Name:
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:4367 ATLANTA HWY
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36109-3171
Mailing Address - Country:US
Mailing Address - Phone:334-558-0906
Mailing Address - Fax:334-558-0910
Practice Address - Street 1:2117 BROAD ST
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-4142
Practice Address - Country:US
Practice Address - Phone:334-356-1111
Practice Address - Fax:334-356-9873
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2023-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2388111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1196252OtherAMERICAN SPECIALTY HEALTH