Provider Demographics
NPI:1750308391
Name:WEISS, BRADLEY J (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:J
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 1:264 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-1141
Mailing Address - Country:US
Mailing Address - Phone:508-655-9008
Mailing Address - Fax:508-651-3805
Practice Address - Street 1:264 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-1141
Practice Address - Country:US
Practice Address - Phone:508-655-9008
Practice Address - Fax:508-651-3805
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA972111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA445545OtherMED GROUP NUMBER
MAY49093Medicare ID - Type Unspecified
U09604Medicare UPIN