Provider Demographics
NPI:1942251970
Name:WEISS FAMILY CHIROPRACTIC CTR
Entity Type:Organization
Organization Name:WEISS FAMILY CHIROPRACTIC CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CETTY
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-753-6077
Mailing Address - Street 1:11924 W FOREST HILL BLVD
Mailing Address - Street 2:STE 13
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414
Mailing Address - Country:US
Mailing Address - Phone:561-753-6077
Mailing Address - Fax:561-753-6095
Practice Address - Street 1:11924 W FOREST HILL BLVD
Practice Address - Street 2:STE 13
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414
Practice Address - Country:US
Practice Address - Phone:561-753-6077
Practice Address - Fax:561-753-6095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5181111N00000X
FL5180111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T85495Medicare UPIN
70730Medicare ID - Type UnspecifiedDR BRADLEY G WEISS
70729Medicare ID - Type UnspecifiedDR CETTY WEISS