Provider Demographics
NPI:1851725386
Name:WEIBEL, ALEXANDRA T (DC)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:T
Last Name:WEIBEL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 MOUNT LASSEN DR
Mailing Address - Street 2:SUITE B 128
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1148
Mailing Address - Country:US
Mailing Address - Phone:415-472-1700
Mailing Address - Fax:
Practice Address - Street 1:7 MOUNT LASSEN DR
Practice Address - Street 2:SUITE B 128
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-1148
Practice Address - Country:US
Practice Address - Phone:415-472-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-03
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29698111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology