Provider Demographics
NPI:1770662595
Name:WEISS, WILLIAM F (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:F
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 1:909 NEWFIELD STREET
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-1817
Mailing Address - Country:US
Mailing Address - Phone:860-632-1022
Mailing Address - Fax:860-635-9501
Practice Address - Street 1:909 NEWFIELD STREET
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-1817
Practice Address - Country:US
Practice Address - Phone:860-632-1022
Practice Address - Fax:860-635-9501
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000696111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT696000OtherCONNECTI CARE HMO
CT050000696CT03OtherBCBS
CT050000696CT03OtherBCBS
T87768Medicare UPIN