Provider Demographics
NPI:1700958766
Name:WEBBER, MARK (DC CCSP)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:WEBBER
Suffix:
Gender:M
Credentials:DC CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10517 NE 38TH PL
Mailing Address - Street 2:BLDG 11
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-7926
Mailing Address - Country:US
Mailing Address - Phone:425-869-2882
Mailing Address - Fax:425-869-0368
Practice Address - Street 1:10517 NE 38TH PL
Practice Address - Street 2:BLDG 11
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-7926
Practice Address - Country:US
Practice Address - Phone:425-869-2882
Practice Address - Fax:425-869-0368
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2933111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
118943OtherL & I
1601715974000Medicare UPIN
AB09995Medicare ID - Type Unspecified