Provider Demographics
NPI:1457911208
Name:UPPER BUCKS WEIGHT MANAGEMENT
Entity Type:Organization
Organization Name:UPPER BUCKS WEIGHT MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:267-733-7119
Mailing Address - Street 1:510 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-1216
Mailing Address - Country:US
Mailing Address - Phone:267-733-7119
Mailing Address - Fax:
Practice Address - Street 1:328 W BROAD ST REAR OFFICE
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-1275
Practice Address - Country:US
Practice Address - Phone:215-804-9530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty