Provider Demographics
NPI:1265437040
Name:WEINER, GILBERT SETH (DC)
Entity type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:SETH
Last Name:WEINER
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 1:456B CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-1884
Mailing Address - Country:US
Mailing Address - Phone:787-783-3253
Mailing Address - Fax:
Practice Address - Street 1:653 CALLE HIPODROMO
Practice Address - Street 2:SUITE #101
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00907-3467
Practice Address - Country:US
Practice Address - Phone:787-783-3253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR242111N00000X
MA3146111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR074008OtherLA CRUZ AZUL
PR6605397810011OtherCIGNA
PR9680006OtherHUMANA
PR602319OtherMEDICARE MUCHO MAS
PR5-1228OtherTRIPLE-S
PR6605397810011OtherCIGNA