Provider Demographics
NPI:1649307026
Name:WEISER CHIROPRACTIC CENTER P. A
Entity type:Organization
Organization Name:WEISER CHIROPRACTIC CENTER P. A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:LEO
Authorized Official - Last Name:WAITE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-414-3881
Mailing Address - Street 1:54 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:WEISER
Mailing Address - State:ID
Mailing Address - Zip Code:83672-1941
Mailing Address - Country:US
Mailing Address - Phone:208-414-3881
Mailing Address - Fax:208-414-3882
Practice Address - Street 1:54 W COURT ST
Practice Address - Street 2:
Practice Address - City:WEISER
Practice Address - State:ID
Practice Address - Zip Code:83672-1941
Practice Address - Country:US
Practice Address - Phone:208-414-3881
Practice Address - Fax:208-414-3882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-437111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDC437-1OtherIDAHO BLUE CROSS
ID1671515Medicare ID - Type UnspecifiedMEDICARE NUMBER