Provider Demographics
NPI:1811399967
Name:WEBER, JACK (DC)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:
Last Name:WEBER
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 1:150 PRESTON EXECUTIVE DR
Mailing Address - Street 2:STE 101
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8485
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:150 PRESTON EXECUTIVE DR
Practice Address - Street 2:STE 101
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8485
Practice Address - Country:US
Practice Address - Phone:919-650-1789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-19
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012699111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor