Provider Demographics
NPI:1891855490
Name:WEBER, JAMES WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WILLIAM
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 1:134 W KNAPP ST
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-1605
Mailing Address - Country:US
Mailing Address - Phone:715-234-3417
Mailing Address - Fax:715-234-3417
Practice Address - Street 1:134 W KNAPP ST
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-1605
Practice Address - Country:US
Practice Address - Phone:715-234-3417
Practice Address - Fax:715-234-3417
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1705111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIT63620Medicare UPIN
WI000135908Medicare ID - Type Unspecified