Provider Demographics
NPI:1700164910
Name:WEBER FAMILY CHIROPRACTIC CLINIC PA
Entity Type:Organization
Organization Name:WEBER FAMILY CHIROPRACTIC CLINIC PA
Other - Org Name:WEBER FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:316-652-7900
Mailing Address - Street 1:241 N HILLSIDE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-4903
Mailing Address - Country:US
Mailing Address - Phone:316-652-7900
Mailing Address - Fax:316-652-7901
Practice Address - Street 1:241 N HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4903
Practice Address - Country:US
Practice Address - Phone:316-652-7900
Practice Address - Fax:316-652-7901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0105375111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty