Provider Demographics
NPI:1871635409
Name:WEISS, LAWRENCE ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:ROBERT
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 1:44170 W. 12 MILE RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377
Mailing Address - Country:US
Mailing Address - Phone:248-624-9393
Mailing Address - Fax:248-773-8740
Practice Address - Street 1:44170 W. 12 MILE RD
Practice Address - Street 2:STE. 100
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377
Practice Address - Country:US
Practice Address - Phone:248-624-9393
Practice Address - Fax:248-773-8740
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007148111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI383418444OtherTAX ID
MI95035449OtherBCBS PROVIDER #
MI3495449Medicaid
MI168901OtherSELECTCARE PROVIDER #
MIP99468OtherBCN PROVIDER #
MIU63344Medicare UPIN
MI168901OtherSELECTCARE PROVIDER #
MI0M69020Medicare ID - Type Unspecified